A rare case of Dermatitis herpetiformis in a child

Abstract

Background: Dermatitis herpetiformis is an inflammatory cutaneous disease with a chronic relapsing course, pruritic, gluten-sensitivity, blister and polymorphic eruptions in genetic predisposed individual. DH is extremely rare among African and Asian population, especially in children. In Mongolia, two cases of children have been diagnosed in the last 5 years. Serology (anti-TTG IgA, anti-gliadin IgA, anti-DGP IgA) and histological findings are important for diagnosis, but direct immunofluorescence is the gold standard for diagnosis for DH. Clinical case: A 13-year-old female presented to the National Center for Skin Diseases with complaints of itchy rashes and occasional flare-ups. The disease first started in the spring of 2022 with a rash on both elbows. Based on questions and physical examination, the preliminary diagnosis was dermatitis herpetiformis. To confirm the final diagnosis, tissue samples were taken from the vesicular lesion and nearby healthy skin. Results: immunological test: Anti-Gliadin IgA 54.9 U/ml, Anti-TTG IgA 2.1 U/ml. Histopathological findings: subepidermal vesicles associated with accumulation of neutrophils at the papillary dermis. On DIF: Granular IgA deposits at the dermal papillae. Conclusion: Dermatitis herpetiformis L13.0 (Dühring’s dermatitis) was diagnosed based on the appearance and characteristics of the clinical symptoms, laboratory, histopathology and direct immunofluorescence tests. We present a case of a 13-year-old female child with symmetrical, grouped polymorphic lesions consisting of erythema, papules and vesicles, involving the extensor surfaces of the knees, elbows, shoulders, buttocks, sacral region.