Punctate pemphigus: an underreported direct immunofluorescence pattern

Intercellular epidermal deposition of immunoglobulin G (IgG) in a continuous net-like or 'chicken wire' pattern is a well-described and diagnostic finding in direct immunofluorescence (DIF) studies of pemphigus. In our experience, punctate or dot-like intercellular deposition of IgG can also be seen in cases of pemphigus but has received little attention in the literature. We describe a series of DIF specimens showing intercellular deposition of IgG in continuous and/or punctate patterns, which occurred with equal frequency in pemphigus vulgaris and pemphigus foliaceus. This series highlights the punctate or dot-like pattern of intercellular IgG deposition in DIF studies of pemphigus, reviews potential mechanisms and calls attention to this potentially under-recognized phenomenon.