A 45-year-old woman comes to the office due to an intensely pruritic rash. Over the last 2 months, she has had a persistent rash characterized by pruritic papules and blisters on her elbows, knees, and buttocks. The patient has no significant medical history and takes no medications. She has a 15-pack-year smoking history and does not use alcohol or illicit drugs.
Skin findings are shown in the image.

This patient's condition is most likely associated with which of the following?

Question

A 45-year-old woman comes to the office due to an intensely pruritic rash.  Over the last 2 months, she has had a persistent rash characterized by pruritic papules and blisters on her elbows, knees, and buttocks.  The patient has no significant medical history and takes no medications.  She has a 15-pack-year smoking history and does not use alcohol or illicit drugs.
Skin findings are shown in the image.

This patient's condition is most likely associated with which of the following?

Quizplus · Accepted Answer

11ec193a_977b_4ba4_853d_67e038ad3de6_MD0002_00 This patient has dermatitis herpetiformis (DH), which is characterized by intensely pruritic, erythematous papules, vesicles, and bullae on the extensor surfaces of the elbows, knees, back, and buttocks. DH is commonly associated with gluten-sensitive enteropathy (celiac disease), but the gastrointestinal features may go undetected in patients with mild or nonspecific manifestations such as fatigue or iron deficiency anemia. The diagnosis of DH can be confirmed by skin biopsy. Histopathology shows a neutrophilic infiltrate, papillary microabscesses, and subepidermal vesicles. Direct immunofluorescence of perilesional skin shows granular IgA deposits in the dermal papillae and is more specific than light microscopy alone. In addition, serologic markers for celiac disease (eg, IgA tissue transglutaminase antibodies, IgA endomysial antibodies) are often helpful. Initial management includes dapsone and a gluten-free diet. (Choice A) Lichen planus (pruritic, purple, papules and plaques with fine white streaks) and leukocytoclastic vasculitis (palpable purpura) due to cryoglobulinemia are associated with hepatitis C infection. Lichen planus (Choice B) Common dermal manifestations of HIV infection include recurrent viral syndromes (eg, shingles, molluscum contagiosum), severe psoriasis, and seborrheic dermatitis. Although the vesicles of DH can cluster in tight groups resembling shingles, this patient's chronic, symmetric lesions are not consistent with shingles. molluscum contagiosum (Choice D) Dermatomyositis is characterized by proximal muscle weakness and inflammatory skin lesions (eg, heliotrope rash at the periorbital area and cheeks, erythematous plaques over the joints and bony prominences of the hands [Gottron papules]). It may occur as a paraneoplastic syndrome; associated cancers include ovarian, lung, and colorectal cancers and non-Hodgkin lymphoma. erythematous plaques (Choice E) Common dermal associations of ulcerative colitis include erythema nodosum (painful erythematous nodules at the lower legs) and pyoderma gangrenosum (painful, enlarging, ulcerating nodules with a violaceous border). erythematous nodules ulcerating nodules Educational objective: Dermatitis herpetiformis is characterized by pruritic papules, vesicles, and bullae on the extensor surfaces of the elbows, knees, back, and buttocks. It is commonly associated with gluten-sensitive enteropathy (celiac disease), but the gastrointestinal manifestations may go undetected in patients with mild, nonspecific signs and symptoms. __________ References: Dermatitis herpetiformis. (http://www.ncbi.nlm.nih.gov/pubmed/22137227)

A 45-Year-Old Woman Comes to the Office Due to an Intensely