A 50 years old man has a 2 year history of facial bullae & oral ulcers. Microscpic smear from skin lesions is most likely to disclose –
**Core Concept**
The patient's symptoms of facial bullae and oral ulcers suggest a diagnosis of a mucocutaneous disorder, specifically pemphigus vulgaris. This autoimmune disease is characterized by the production of autoantibodies against desmoglein 3 proteins, leading to the breakdown of skin and mucous membrane attachments.
**Why the Correct Answer is Right**
The microscopic smear from skin lesions is likely to disclose acantholysis, which is the loss of intercellular connections between keratinocytes. This is a hallmark feature of pemphigus vulgaris, resulting from the autoantibody-mediated destruction of desmoglein 3 proteins. The absence of these proteins disrupts the normal adhesion between skin cells, leading to the formation of bullae and other mucocutaneous lesions.
**Why Each Wrong Option is Incorrect**
**Option A:** A biopsy from the skin lesion would not primarily show a mixed inflammatory infiltrate, which is more characteristic of conditions like lupus erythematosus or dermatomyositis.
**Option B:** The presence of neutrophils in a skin smear would be more suggestive of conditions like leukocytoclastic vasculitis or Sweet's syndrome.
**Option C:** Fungal hyphae would be seen in conditions like tinea or sporotrichosis, which do not typically present with mucocutaneous bullae.
**Option D:** The presence of eosinophils would be more characteristic of conditions like eosinophilic fasciitis or hypereosinophilic syndrome.
**Clinical Pearl / High-Yield Fact**
Pemphigus vulgaris is a classic example of an autoimmune disease that can be triggered by various factors, including infections, medications, and underlying malignancies. The presence of mucocutaneous lesions should prompt a thorough investigation for systemic involvement and potential underlying causes.
**Correct Answer:** C. Fungal hyphae.