Athena: Speciality Certificate Examination case for Dermatopathology

A 43‐year‐old Taiwanese man presented to the emergency department with flaccid oral and genital blisters, which developed after 2 weeks of a generalized erythematous macular rash. He reported conjunctivitis and was Nikolsky positive. He had recently been started on lamotrigine. His sister also had a similar problem the previous year with an antiepileptic drug. Toxic epidermal necrolysis (TEN) is suspected.

Skin biopsy showed the following features: paucicellular subepidermal blister cavity, partial and full‐thickness necrosis of the overlying epidermis, normal surface orthokeratin and a mild perivascular chronic inflammatory infiltrate.