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Pemphigus is a group of autoimmune bullous diseases mediated by autoantibodies most often of the immunoglobulin G class, subclasses immunoglobulin G1, and immunoglobulin G4 (IgG4), directed against desmosomal adhesion proteins of keratinocytes. This study aimed to evaluate IgG4 immunoreactivity on paraffin sections using immunohistochemistry in patients with pemphigus as a diagnostic test. Fifty formalin-fixed paraffin-embedded specimens from patients with pemphigus were selected.

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Department of Dermatology, KCU-GME Consortium/Advanced Dermatology and Cosmetic Surgery, Orlando, FL, USA.

This case report discusses two clinical encounters of a 62-year-old Hispanic woman initially hospitalized with suspected Stevens-Johnson syndrome, later correctly diagnosed with bullous fixed drug eruption during an outpatient visit for a similar eruption. The first encounter involved an extensive evaluation and an 11-day hospital stay, while the second was managed successfully as an outpatient with oral prednisone. This report highlights the importance of differentiating bullous fixed drug eruption from Stevens-Johnson syndrome/toxic epidermal necrolysis and emphasizes the need for a collaborative approach between Primary Care Providers and Dermatology to ensure optimal patient care.

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