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  #1  
Old 10-02-2011
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Default Pathology questİon

An elderly woman with a history of multiple oral ulcers presents with flaccid bullae on her scalp, face, and trunk. Manual pressure on the skin produces separation of the upper layer of the epidermis, followed by eventual sloughing of the skin. The patient has been in relatively good health until recently, and denies taking any medications. A biopsy of one of the skin lesions reveals separation of epithelial cells above the basal layer. Autoantibodies to which of the following components would most likely be found in this patient?
A. Epidermal basement membrane proteins
B. Glycoprotein IIb/IIIa
C. Intercellular junctions of epidermal cells
D. Intrinsic factor
E. Type IV collagen
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Old 10-03-2011
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•C. Intercellular junctions of epidermal cells

pemphigus vulgaris ( IgG around the cell of epidermis ) with postive nikolisky sign
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Old 10-03-2011
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Pemphigus involves mouth,,bullous doesn't

agreed with Miss Patho its C
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Old 10-03-2011
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Correct Answer Answer

C is correct.
This is a case of pemphigus vulgaris. Autoantibodies against Desmoglein proteins which are present in cell-cell junctions between epithelial cells.

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Old 10-03-2011
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C. Intercellular junctions of epidermal cells
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Old 10-04-2011
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The correct answer is C. Bullae with the cleavage plane above the basal layer of the epidermis suggests pemphigus vulgaris, which is caused by autoantibodies to intercellular junctions of epidermal cells. The autoantibodies decrease the ability of the keratinocytes to adhere to one another, permitting formation of vesicles and bullae. Oral involvement is common, and often precedes the characteristic skin lesions. Separation of the epidermis upon manual stroking of the skin is known as Nikolsky's sign. This sign is present in other disorders such as Stevens-Johnson syndrome, but we are told the woman is not taking any medications, a typical cause of Stevens-Johnson syndrome in the adult population.
Antibodies to epidermal basement membrane proteins (choice A) are seen in bullous pemphigoid, which is a bullous disease characterized by blisters with a cleavage line between the epidermis and dermis.
Antibodies to glycoprotein IIb/IIIa (choice B) are seen in autoimmune thrombocytopenic purpura.
Antibodies to intrinsic factor (choice D) are seen in pernicious anemia.
Antibodies to Type IV collagen (choice E) are seen in Goodpasture's syndrome.
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