Solve the Medical Riddle: She Has Blisters in Her Mouth and on Her Body, Second Week

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

Last week, the patient reported her symptoms. The doctor proceeded with the examination using the components of the classic S-O-A-P notes, which are as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

The doctor suspectedthat Zoe has a systemic blistering lesion condition that was not likely to be drug-related. He ordered blood work and referred Zoe to a dermatologist associated with a university..

The dermatologist reviewedher history, physical exam, and the results of the blood tests and performed the following additional tests:

Skin Biopsy: Histopathology (a biopsy and look under a microscope) from the edge of a blister.                         

Direct immunofluorescence (DIF)on normal-appearing perilesional (area around the erosion) skin. When DIF testing is performed on lesional skin, false-positive results can be observed, so a biopsy and DIF of skin surrounding the lesion is important.

Blood Test: Indirect immunofluorescence (IDIF)using the patient’s serum if DIF results are positive. IDIF demonstrates the presence of circulating IgG autoantibodies that bind to theepidermis.

To be continued . . .

Come back to next Thursday to find out what some people have guessed the diagnosis might be.

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit

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