Acta Dermato-Venereologica 98-8CompleteContent | Page 29

815 Blisters, Sores and Scars on the Dorsal Hands in a 17-year-old Girl: A Quiz Anna Trier Heiberg BRIX 1 , Anne Lindegaard CHRISTIANSEN 2 and Anette BYGUM 1 1 Department of Dermatology and Allergy Centre, and 2 Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, DK- 5000 Odense, Denmark. E-mail: [email protected] A 17-year-old girl was referred to the department of der- matology due to blisters and sores on both hands for some months. She reported having fragile skin, tense blisters, slow healing sores and development of scars. In addition to the cutaneous symptoms she had muscle weakness in her arms and hands, along with reduced sensibility acrally. Before her referral, a neurological examination confirmed reduced muscle strength in the hands and decreased peripheral sen- sibility. Magnetic resonance imaging of the cerebrum, and electroneurography, were normal. A subsequent psychiatric evaluation concluded that she was psychologically fragile, but found no evidence of depression or attention deficit hyperactivity disorder. Biochemically she had prolonged raised alanine aminotransferase (ALAT) of 181-106-81-66 U/l [normal 10–45 U/l], while complete blood count, kidney and other liver function tests were normal. The medical treatment at time of presentation was oral contraceptives and a daily multivitamin tablet. What is your diagnosis? See next page for answer. Fig. 1. Seventeen-year-old girl with fragile skin, sores and scars on her hands. QUIZ SECTION This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica. doi: 10.2340/00015555-2962 Acta Derm Venereol 2018; 98: 815–816