A renal transplant recipient on mycophenolate mofetil develops tense blisters; biopsy shows subepidermal bulla with neutrophils. DIF shows linear IgG at BMZ. Indirect IF on salt-split skin shows fluorescence on the dermal floor. The likely diagnosis is:

• A Epidermolysis bullosa acquisita ✓
• B Bullous pemphigoid
• C Mucous membrane pemphigoid
• D Linear IgA bullous dermatosis

Explanation

Epidermolysis bullosa acquisita (EBA) targets type VII collagen (anchoring fibrils in sub-lamina densa). Since type VII collagen is on the dermal side, indirect IF on salt-split skin shows dermal floor staining — the key distinguishing feature from BP (which binds to the epidermal roof/lamina lucida). EBA is associated with inflammatory bowel disease; the neutrophil-rich infiltrate and mechanical blister pattern are characteristic.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.