Childhood pemphigus initially seen as eosinophilic spongiosis

The condition of a 3-year-old boy with an intermittent, generalized, bullous eruption was initially diagnosed as (and treated as) bullous impetigo. After a relapse, two skin biopsies were performed. Each biopsy specimen showed the changes of eosinophilic spongiosis. A third biopsy specimen was also examined by direct immunofluorescence microscopy. The specimen showed deposition of IgG in the intercellular region of the epidermis. The patient's serum contained intercellular antibodies in a dilution of 1:160, confirming the diagnosis of pemphigus. A biopsy should be performed in the case of a child with a persistent or recurring bullous eruption; immunofluorescence microscopy of the biopsy is essential.