The sensitivity and specificity of "caterpillar bodies" in the differential diagnosis of subepidermal blistering disorders

Maxwell A Fung, Michael J. Murphy, Diane M. Hoss, Adrienne Berke, Jane M. Grant-Kels

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Caterpillar bodies are eosinophilic, elongated, segmented bodies located within the roofs of blisters and are considered to represent a specific histopathologic feature of porphyric bullous eruptions, including porphyria cutanea tarda and erythropoietic protoporphyria. The possibility that similar or identical bodies may be present in other disorders prompted further study exploring the specificity of caterpillar bodies in the differential diagnosis of subepidermal vesiculobullous disorders. Seventy-six cases exhibiting subepidermal clefting were reviewed by light microscopy. "Classic" caterpillar bodies were present in porphyria cutanea tarda (6 of 14) and 1 case representing either venous stasis-associated bulla or possibly bullosis diabeticorum. Caterpillar body-like clusters were present in porphyria cutanea tarda (5 of 14), erythropoietic protoporphyria (1 of 3), bullous pemphigoid (7 of 24), and junctional or dystrophic epidermolysis bullosa (3 of 5). In some cases, classic caterpillar body and caterpillar body-like clusters coexisted in a blister roof. Caterpillar bodies or caterpillar body-like clusters were not identified in any cases of dermatitis herpetiformis, linear IgA bullous dermatosis, bullous erythema multiforme, epidermolysis bullosa acquisita, or wound-healing reactions. In contrast to caterpillar bodies, caterpillar body-like clusters were negative for PAS or Type IV collagen stains. In conclusion, caterpillar bodies appear to represent a specific feature of porphyria cutanea tarda (specificity, 98%) but were present in less than half of those cases in this study (sensitivity, 43%). Caterpillar body-like clusters are less specific and may be present in porphyria cutanea tarda, erythropoietic protoporphyria, pseudoporphyria, bullous pemphigoid, epidermolysis bullosa, and epidermolysis bullosa acquisita.

Original languageEnglish (US)
Pages (from-to)287-290
Number of pages4
JournalAmerican Journal of Dermatopathology
Volume25
Issue number4
DOIs
StatePublished - Aug 2003

Fingerprint

Porphyria Cutanea Tarda
Erythropoietic Protoporphyria
Differential Diagnosis
Sensitivity and Specificity
Blister
Epidermolysis Bullosa Acquisita
Bullous Pemphigoid
Linear IgA Bullous Dermatosis
Junctional Epidermolysis Bullosa
Epidermolysis Bullosa Dystrophica
Epidermolysis Bullosa
Dermatitis Herpetiformis
Erythema Multiforme
Collagen Type IV
Wound Healing
Microscopy
Coloring Agents
Light

Keywords

  • Basement membrane
  • Bullous diseases
  • Caterpillar body
  • Porphyria

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Dermatology

Cite this

The sensitivity and specificity of "caterpillar bodies" in the differential diagnosis of subepidermal blistering disorders. / Fung, Maxwell A; Murphy, Michael J.; Hoss, Diane M.; Berke, Adrienne; Grant-Kels, Jane M.

In: American Journal of Dermatopathology, Vol. 25, No. 4, 08.2003, p. 287-290.

Research output: Contribution to journalArticle

Fung, Maxwell A ; Murphy, Michael J. ; Hoss, Diane M. ; Berke, Adrienne ; Grant-Kels, Jane M. / The sensitivity and specificity of "caterpillar bodies" in the differential diagnosis of subepidermal blistering disorders. In: American Journal of Dermatopathology. 2003 ; Vol. 25, No. 4. pp. 287-290.
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abstract = "Caterpillar bodies are eosinophilic, elongated, segmented bodies located within the roofs of blisters and are considered to represent a specific histopathologic feature of porphyric bullous eruptions, including porphyria cutanea tarda and erythropoietic protoporphyria. The possibility that similar or identical bodies may be present in other disorders prompted further study exploring the specificity of caterpillar bodies in the differential diagnosis of subepidermal vesiculobullous disorders. Seventy-six cases exhibiting subepidermal clefting were reviewed by light microscopy. {"}Classic{"} caterpillar bodies were present in porphyria cutanea tarda (6 of 14) and 1 case representing either venous stasis-associated bulla or possibly bullosis diabeticorum. Caterpillar body-like clusters were present in porphyria cutanea tarda (5 of 14), erythropoietic protoporphyria (1 of 3), bullous pemphigoid (7 of 24), and junctional or dystrophic epidermolysis bullosa (3 of 5). In some cases, classic caterpillar body and caterpillar body-like clusters coexisted in a blister roof. Caterpillar bodies or caterpillar body-like clusters were not identified in any cases of dermatitis herpetiformis, linear IgA bullous dermatosis, bullous erythema multiforme, epidermolysis bullosa acquisita, or wound-healing reactions. In contrast to caterpillar bodies, caterpillar body-like clusters were negative for PAS or Type IV collagen stains. In conclusion, caterpillar bodies appear to represent a specific feature of porphyria cutanea tarda (specificity, 98{\%}) but were present in less than half of those cases in this study (sensitivity, 43{\%}). Caterpillar body-like clusters are less specific and may be present in porphyria cutanea tarda, erythropoietic protoporphyria, pseudoporphyria, bullous pemphigoid, epidermolysis bullosa, and epidermolysis bullosa acquisita.",
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