Falsely Normal Direct Immunofluorescent Microscopic Findings in Bullous Impetigo

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Abstract
To the Editor.— Circulating antibodies against the intercellular cement of the epidermis are pathognomic for pemphigus and its clinical variants.1 They have been described in other diseases, eg, toxic epidermal necrolysis, drug eruption, superficial fungal infection, lepromatous leprosy, myasthenia gravis, and thermal burns.2 Recently, a patient with bullous mycosis fungoides and a patient with bullous impetigo have been described in whom such antibodies were found.3 We report herein a case of bullous impetigo with immunopathologic features of pemphigus. Report of a Case.— A 40-year-old man was seen because of the sudden onset of several small bullae on his right buttock. No mucous membrane lesions were noted. The acute onset of the eruption and the noninflammatory nature of the bullae prompted a biopsy of the lesion. On hematoxylin-eosin staining, a bulla was seen high in the epidermis. Little, if any, inflammatory infiltrate was seen in the dermis. Because

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