Autoimmune Bullous Diseases

A 62-year-old with weeks of severe oral erosions and flaccid bullae on trunk. Nikolsky sign positive; DIF shows intercellular IgG/C3 in a “fishnet” pattern. Best first-line systemic therapy?

A 74-year-old with intensely pruritic urticarial plaques and tense bullae on abdomen; Nikolsky negative. DIF shows linear IgG/C3 at BMZ; IIF salt-split binds roof. Diagnosis?

A 35-year-old with grouped pruritic vesicles on elbows and buttocks; DIF shows granular IgA at dermal papillae. Best initial drug therapy?

A 58-year-old with PV asks about target antigens. Which is correct?

A 70-year-old on furosemide and a DPP-4 inhibitor develops BP. Beyond stopping culprit meds, a steroid-sparing regimen with favorable safety in elderly?

A biopsy for suspected AIBD is planned. Best sampling strategy for DIF?

A 66-year-old with trauma-induced tense blisters on hands/feet, atrophic scars and milia; salt-split shows floor binding; antibodies to type VII collagen. Diagnosis?

A 28-year-old with extremely painful, recalcitrant stomatitis, conjunctival erosions, and a polymorphous eruption; antibodies to envoplakin/periplakin; underlying Castleman tumor. Diagnosis?

A 51-year-old woman in late pregnancy develops intensely pruritic periumbilical plaques progressing to tense blisters. DIF: linear C3>IgG at BMZ. Diagnosis?

A man from Brazil with crusted erosions in seborrheic areas; flaccid superficial blisters; DIF: intercellular IgG mainly in upper epidermis. Diagnosis?

A 63-year-old with BP limited to trunk and limbs, caregiver available for applications. Most effective first-line local therapy?

Which serology best supports DH and monitors dietary adherence?

A 45-year-old with PV has “row of tombstones” on H&E. What does this represent?

A child with annular plaques of vesicles and “string-of-pearls” arrangement; DIF: linear IgA along BMZ. Triggered by recent vancomycin. Best treatment?

A patient with ocular scarring, symblepharon, and oral erosions; DIF: linear IgG at BMZ; target antigens include laminin-332. Key oncologic implication?

A 76-year-old with BP asks about disease associations. Which is most established?

Salt-split skin IIF shows dermal-floor binding of circulating IgG. Which diagnosis fits best?

Which statement about pemphigus foliaceus is true?

A 60-year-old with BP poorly controlled on clobetasol and doxy/niacinamide. Next systemic step with favorable steroid-sparing efficacy?

A 33-year-old with DH asks about non-drug management. Best advice?

A 68-year-old with tense bullae, eosinophil-rich infiltrate on H&E, and anti-BP180 antibodies. Which bedside sign supports BP?

In suspected PV, which lab pair is most specific?

A 72-year-old with widespread BP and diabetes cannot use prolonged systemic steroids. Evidence-based alternative induction?

A 54-year-old with PV on high-dose prednisone develops hyperglycemia and infections. Most appropriate steroid-sparing induction/maintenance?

A 9-month-old infant of a mother with active PV has transient erosions at birth. Explanation?

Which drug is classically linked to inducing PV-like disease?

A 59-year-old with mucosal-dominant PV has severe oral pain limiting intake. Helpful adjunct for mucosal pain while systemic therapy takes effect?

A 71-year-old with BP develops secondary infection risk. Which monitoring is essential when using doxycycline/niacinamide?

A 43-year-old with pruritic annular urticarial plaques that evolve into tense bullae; eosinophilia present. Which histologic clue supports BP?

For MMP with sight-threatening ocular disease, which systemic strategy is preferred?

A 50-year-old with “cluster of jewels” vesicles and linear IgA at BMZ; no drug triggers. Which antigen is often implicated?

A 67-year-old with suspected EBA related to inflammatory bowel disease. Which clinical subtype would most suggest EBA over BP?

Before initiating dapsone in DH/LAD, what baseline test is mandatory?

A 64-year-old with PV partially responsive to rituximab asks about relapse monitoring. Most useful lab for activity?

A 78-year-old with BP on prednisone develops severe hyperglycemia; family declines rituximab. Reasonable steroid-sparing alternative?

Which DIF pattern best distinguishes DH from linear IgA disease?

A 57-year-old with BP asks which malignancy screening is mandatory due to direct disease association. Best answer?

A 30-year-old with mucosal-dominant PV and severe odynophagia is admitted. Which supportive measure is crucial early?

An elderly patient with pruritic eczematous plaques precedes blisters by weeks; BP180 ELISA borderline. Best next diagnostic step?

A 48-year-old with paraneoplastic pemphigus and new dyspnea/cough; CT shows air-trapping and bronchiolitis. Likely complication?

A 49-year-old with flaccid pustules in flexures; H&E shows subcorneal pustules; DIF: intercellular IgA in upper epidermis. Best therapy?

A 31-year-old woman with SLE develops widespread tense vesicles; H&E: neutrophil-rich subepidermal blisters; DIF: linear/granular IgG/IgM/C3; serum anti–type VII collagen. Best first-line?

A 70-year-old man has scarring plaques and tense blisters on scalp/neck with cicatricial alopecia; mucosa spared; DIF: linear IgG at BMZ. Diagnosis?

A 62-year-old with PV on prednisone 60 mg/day improves; plan to taper. Best taper strategy?

Pre-rituximab counseling for PV includes which vaccine advice?

A 68-year-old on PD-1 inhibitor for melanoma develops pruritic tense bullae and BP180 antibodies. Best initial dermatologic plan?

During workup of a single intact tense blister, how do you optimize salt-split interpretation?

A 44-year-old with painful oral erosions only, no skin lesions; ELISA: high anti–Dsg3, low/negative anti–Dsg1. Diagnosis?

A 5-year-old with annular clusters of vesicles (“string of pearls”) on trunk/extremities; DIF: linear IgA at BMZ. Best therapy?

A 76-year-old with severe, refractory BP and high IgE levels has debilitating pruritus despite steroids/doxy. Useful biologic adjunct?

Considering azathioprine as a steroid-sparing agent in PV. Mandatory baseline test?

A 59-year-old PV patient with recalcitrant disease on steroids/MMF. Rapid autoantibody removal strategy?

A 33-year-old with life-threatening PV involving oropharynx and airway edema. Which immediate adjunct is appropriate?

A 30-year-old pregnant woman at 28 weeks develops periumbilical urticarial plaques → tense bullae; fetal monitoring normal. Counseling?

A 57-year-old on dapsone for DH develops cyanosis and low pulse oximeter readings but normal PaO2. Likely adverse effect?

Which immunoglobulin subclass predominates in classic BP pathogenic antibodies?

A bedside test in suspected PV shows acantholytic cells. What is this test?

Subcorneal pustular eruption with negative bacterial culture; DIF: intercellular IgA. What diagnosis is distinguished from Sneddon–Wilkinson?

Intertriginous vegetating plaques with malodorous erosions; histology shows suprabasal acantholysis and eosinophilic microabscesses. Diagnosis?

A patient with a seborrheic-distribution erosive eruption; DIF: both intercellular IgG and granular IgG/C3 at DEJ. Diagnosis?

Painful erosive oral PV—what targeted local measure improves function while systemic therapy starts?

Extensive BP in a nursing-home resident. Which nursing protocol reduces complications?

A 69-year-old with oral erosions, conjunctival scarring, and hoarseness. Which consultation is urgent?

A 55-year-old with choking episodes; laryngoscopy shows posterior commissure scarring; DIF: linear IgG at BMZ. Best classification?

Rural Brazil resident with PF; what epidemiologic fact is relevant?

A 77-year-old develops BP after starting a DPP-4 inhibitor. Beyond withdrawal, which regimen is appropriate?

A newborn of a mother with pemphigoid gestationis has several tense blisters on day 1. Best approach?

A 60-year-old with widespread erosions; DIF negative after weeks of high-potency topical steroids. How to improve diagnostic yield?

Adult with linear IgA disease—common medication trigger?

A 64-year-old with BP has persistent eosinophilia and severe itch. Which lab can also help monitor disease?

Starting rituximab in PV—what infectious risk needs specific prophylaxis/screening?

A 72-year-old with BP and recalcitrant pruritus despite control of new blisters. Helpful adjunct?

A 36-year-old postpartum woman with DH wants to breastfeed while on dapsone. Key counseling?

Elderly patient with weeks of intensely pruritic urticarial plaques; no blisters yet; BP180 ELISA positive. Best step?

A 58-year-old with PV on high-dose steroids develops oral thrush. Best preventive/therapeutic measure?

A 67-year-old with BP and severe diabetes/CKD needs a steroid-sparing agent; which has favorable renal profile?

What patient education reduces trauma-induced blistering in mechanobullous EBA?

A 74-year-old presents with generalized nodular prurigo-like lesions preceding blisters; biopsy later confirms BP. What is this phase called?

Which lab pair best tracks remission/relapse in PV?

A 52-year-old with DIF showing linear IgG on both roof and floor of salt-split skin. Interpretation?

A 63-year-old with flaccid erosions and intact blisters on the chest. Gentle lateral pressure on an intact blister spreads it; rubbing uninvolved skin causes epidermal shearing. Which signs are present?

An 80-year-old with rapidly progressive ocular MMP has symblepharon and corneal erosion despite topical therapy and doxycycline. Best next systemic approach?

A 71-year-old with BP asks about salt-split results. Where do BP autoantibodies bind?

A 55-year-old man with scarring oral erosions, hoarseness, and positive DIF for linear IgG at BMZ is suspected of MMP. Which antigen is linked to higher malignancy risk?

A 39-year-old with annular pruritic plaques and vesicles; histology shows PV-type intercellular IgG but clinical pattern mimics DH. Diagnosis?

A 67-year-old with suspected PV. Which substrate is most sensitive for IIF screening of circulating antibodies?

A 60-year-old with suspected pemphigoid. Optimal IIF substrate?

A 52-year-old with painful oral PV erosions cannot eat. What targeted local therapy eases symptoms while systemic therapy begins?

A 75-year-old with BP has urticarial prodrome for weeks before bullae. What is the best confirmatory test?

A 70-year-old with severe PV requires rituximab. Which infection screen is mandatory?

A 28-year-old at 30 weeks’ gestation has periumbilical plaques that evolve to tense bullae; C3 dominant on DIF. Which fetal risk is most recognized?

A 63-year-old with mechanobullous EBA. Which DIF serration pattern is characteristic?

A 58-year-old with PV is started on azathioprine as a steroid-sparing agent. Which baseline and early-monitoring labs are essential?

A 47-year-old with DH on dapsone develops new fatigue and dark urine. Vitals stable. First test?

A 66-year-old with BP controlled on topical clobetasol asks about systemic antibiotics. Evidence-based steroid-sparing oral option?

A 51-year-old with widespread PV on rituximab develops recurrent sinusitis and low IgG. Next step?

A 72-year-old with BP and CKD needs a steroid-sparing agent. Which is preferred?

A 36-year-old with suspected PNP develops progressive dyspnea; CT shows mosaic attenuation and air-trapping. Life-threatening complication?

A 61-year-old with LAD after vancomycin exposure. Beyond stopping the drug, what first-line medication helps?

A 59-year-old with PV asks why mucosa is worse than skin. Best explanation?

A 68-year-old with BP on high-dose prednisone develops brittle diabetes and edema. Best principle for steroid taper?

A 45-year-old with erosive gingivitis and conjunctival scarring; DIF from buccal mucosa is negative. Best next diagnostic step?

A 73-year-old with BP is pruritic at night despite few new blisters. Helpful adjuvant for itch?

A 29-year-old with PV is starting rituximab. Which vaccine schedule is appropriate?

A 64-year-old with suspected EBA has trauma-induced blisters and milia. Which associated disease warrants review?

A 70-year-old with BP has tense bullae that become secondarily infected. Best wound-care strategy?

A 41-year-old with PV on high-dose steroids develops odynophagia and retrosternal pain. Concern and next step?

A 62-year-old with intertriginous vegetating plaques; biopsy shows suprabasal acantholysis with eosinophils; DIF intercellular IgG. Best diagnosis?

A 56-year-old with suspected drug-induced pemphigus has been on penicillamine and captopril. Which classically induces thiol-type pemphigus?

A 74-year-old with BP starts doxycycline/niacinamide. Which counseling is important?

A 52-year-old with PV on mycophenolate develops leukopenia. Best action?

A 66-year-old with BP after starting vildagliptin. Which statement is correct?

A 34-year-old with DH asks about long-term management. Which non-drug measure reduces relapse and lymphoma risk?

A 48-year-old with PV has intertriginous maceration and candidiasis. Helpful adjunct while tapering steroids?

A 70-year-old with BP has positive BP180 (NC16A) ELISA titers that parallel disease. How usefully can titers guide care?

A 59-year-old with suspected pemphigus sends a blister for histology. Which biopsy is best for routine H&E and for DIF, respectively?

A 44-year-old with PV receives pulse methylprednisolone 1 g/day ×3 for a flare. Which prophylaxis can be considered during high-dose steroids?

A 62-year-old with PV stabilized after rituximab asks about disease course. What is a common pattern?

A 69-year-old with BP on topical therapy asks about prognosis. Most accurate statement?

A 58-year-old with suspected PNP has severe stomatitis, lichenoid papules, and positive anti-plakin antibodies. What malignancy search is most pertinent?