A herpetiform eruption with unexpected immunofluorescence findings

Abstract

A 63-year-old man presented with an 8-week history of a progressive, pruritic eruption affecting his trunk and limbs. He had a history of ischaemic heart disease. There had been no recent change in medication, and the patient did not report any history of personal or family history of dermatological disease. Physical examination revealed clusters of erythematous papulovesicles, small de-roofed bullae and excoriated lesions distributed in a symmetrical herpetiform pattern over the trunk and extensor surfaces of the limbs (Fig. 1). There was no mucosal involvement. Routine laboratory tests including haematinics, thyroid function and an autoimmune screen were unremarkable. The patient underwent a diagnostic skin biopsy sampled from his lower back.