Haemorrhagic form of dermatitis herpetiformis

Introduction
Dermatitis herpetiformis is a chronic autoimmune bullous disease related to gluten intolerance with a polymorphic form of lesions that imitates other dermatoses and causes important diagnostics difficulties.

Objective
To report a case of a very rarely diagnosed haemorrhagic form of Duhring disease, which developed in a 72-year-old man.

Case report
This article presents a description of a patient with lesions located on smooth body skin and scalp, which lasted for several months and had the character of erythematopapular eruptions with a haemorrhagic component and secondary erosions and scabs. The skin lesions had an annular structure and the distribution was symmetrical with the greatest intensity at the elbows, knees, buttocks and thighs. Histopathological examination, direct immunofluorescence, indirect immunofluorescence and the immunoblot method allowed diagnosing Duhring disease. Incorporated pharmacological treatment with dapsone and a gluten-free diet resulted in a significant clinical improvement.

Conclusions
The presented case draws attention to atypical clinical presentation and the appearance time of the first symptoms of dermatitis herpetiformis.