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72-year-old man presents with large, tense, pruritic bullae on the lower abdomen, groin, and inner thighs. Skin biopsy reveals IgG antibodies with linear immunofluorescence at the epidermal basement membrane. To what cell junctions are the antibodies binding?
A. Adherens junctions
B. Desmosomes
C. Gap junctions
D. Hemidesmosomes
E. Tight junctions
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D is the correct answer
This man™s clinical presentation suggests bullous pemphigoid, which is an autoimmune disorder with IgG antibody against epidermal basement membrane hemidesmosomes (choice D). This disorder is similar, but not as severe as pemphigus vulgarus, which affects desomosomes (choice B). Pemphigus vulgaris usually affects the oral mucosa as well, while bullous pemphigoid spares the oral mucosa.
Adherens junctions (choice A), gap junctions (choice C), and tight junctions (choice E) are other cell junctions that are not involved in bullous pemphigoid.