update. 4 punch biopsies later, (one neg direct Immunofluore | Figure 1

update. 4 punch biopsies later, (one neg direct Immunofluorescence), all consistent with intra epidermal blisters, spongiotic derm with eos & lymphs (no neutrophils), mainly superficial. Ddx includes 1) rare/genetic blistering dermatosis, 2) atypical bullous pemphigoid/PV, 3) arthropod bite or drug eruption. All former listed ruled out in favor of drug rxn. Pt disclosed thyroid meds were switched (different brand and dose) prior to eruption. Meds switched - rash apparently resolving with PIH. Thx jplonza and nebushwalker!

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