Multiple bullae on the trunk.

Volume 89, Number 1 www.aafp.org/afp American Family Physician 7 A 62-year-old man with no significant medical history presented with multiple bullae on his trunk that had been present for one week. The rash was painful but not pruritic. He did not have a fever or sore throat, and had not used any new medications. Physical examination revealed multiple vesicles, flaccid bullae, and erosions with crust formation on the chest, abdomen, and back (Figures 1 and 2). Mucosal erosions and the Nikolsky sign were also present. There was no lymphadenopathy. Biopsy of a blister showed suprabasal acantholysis with intraepidermal blister formation and follicular involvement. Direct immunofluorescence revealed intercellular deposits of immunoglobulin G and C3 within the epidermis.