S13C24aP22a-Herpes

S13C24aP22a-2: At higher magnification, the patterns to the left are “erythema multiforme-like.” The patterns in the vesicle are also acceptable in the category of erythema multiforme. The vesicle is reticulated; outlining some of the defects, there are remnants of epidermis in the pattern of ghost cells .

S13C24aP22a-3: The patterns of a lichenoid lymphocytic vasculitis are combined with those of whorled transepidermal elimination. The combination of features satisfies the basic criteria for the diagnosis of erythema multiforme.


S13C24aP22a-1: This is a lesion of erythema multiforme (at least by clinical characteristics). The vesicle is multiloculated and reticulated. The defects contain proteinaceous fluid. To the left of the vesicle, there is a cluster of necrotic keratinocytes at the dermal-epidermal interface. Green arrows identify similar, but smaller, clusters of necrotic cells in transit to the surface of the skin. To the left, there are prominent, band-like infiltrates at the dermal-epidermal interface. Focally, there are sub-epidermal defects in cell-rich, lichenoid patterns.

S13C24aP22a-4: The vesicle is reticulated. Some of the epithelial partitions are necrotic (i.e., ghost cells form irregular sheets). Lytic defects contain degenerating inflammatory cells and necrotic keratinocytes. There is a pattern of whorled transepidermal elimination in the epidermis to the left. Violet arrows point to nuclei with pale inclusions (herpes virus-like inclusions).

S13C24aP22a-5: Violet arrows identify nuclei containing pale inclusions.

S13C24aP22a-6: Blue arrows identify herpes virus-like inclusions in nuclei. There are patterns of ballooning degeneration. A portion of the lumen of the vesicle is represented in the upper right portion of the field. There are scattered necrotic keratinocytes. For some examples of clinical erythema multiforme, markers for intranuclear viral inclusions can be identified in the epidermis. For at least some examples of post-herpes EM, the presence of morphologic intra-nuclear inclusions might be cited as evidence that this variant of EM actually is a manifestation of a virus infection.

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