A patient with bullous pemphigoid has a biopsy showing eosinophilic spongiosis without a fully developed blister. This histopathological finding represents:

• A An unrelated incidental finding requiring repeat biopsy
• B A drug-induced reaction rather than autoimmune bullous disease
• C Allergic contact dermatitis masquerading as pemphigoid
• D An early pre-bullous stage of bullous pemphigoid ✓

Explanation

Eosinophilic spongiosis is recognized as an early pre-bullous histopathological stage of bullous pemphigoid, preceding frank subepidermal blister formation. It can be seen in the urticarial plaques that precede blistering. DIF is essential to confirm the diagnosis in such early lesions, as HPF alone may be misinterpreted. It is not incidental and does not indicate contact dermatitis or drug reaction.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.