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Images in Clinical Practice
ARTICLE IN PRESS
doi:
10.25259/IJDVL_395_2021

Hypopyon sign in pemphigus vulgaris

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
Corresponding author: Dr. Vishal Gupta, Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India. doctor.vishalgupta@gmail.com
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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Taneja N, Arava S, Gupta V. Hypopyon sign in pemphigus vulgaris. Indian J Dermatol Venereol Leprol, doi: 10.25259/IJDVL_395_2021.

A 30-year-old lady was hospitalized with a five-month history of oral erosions and a generalized vesiculobullous eruption. Some of these blisters had a layer of pus at the bottom, sharply separated from clearer fluid on top, showing the so-called “hypopyon sign” [Figure 1]. Skin biopsy demonstrated a ‘row of tombstones’ appearance of the epidermal basal layer along with several acantholytic cells. Direct immunofluorescence examination showed epidermal intercellular IgG deposits, confirming the diagnosis of pemphigus vulgaris.

Figure 1:: Several blisters on the abdomen with a layer of pus at the bottom and serous fluid on top (hypopyon sign)

“Hypopyon sign” or “half-half blister” describes small vesicles that turn pustular with pus characteristically accumulating in the lower half of the vesicle. It is better appreciated when the patient stands upright. Standard texts generally mention the hypopyon sign only in the context of subcorneal pustular dermatosis.1 However, it is important to remember that this sign may not be specific to a particular disease, but can be seen in several bullous disorders as a result of the ongoing inflammation.2

Declaration of patient consent

The patient's consent is not required as the patient's identity is not disclosed or compromised.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , . Images in clinical medicine. “Half-half” blisters. N Engl J Med. 2012;366:e31.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , . Hypopyon sign in pemphigus vulgaris and pemphigus foliaceus. Int J Dermatol. 2009;48:1100-2.
    [CrossRef] [PubMed] [Google Scholar]

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