33-year-old woman comes to the office due to blistering on the backs of her hands. She has had occasional
blisters in the past, but numerous lesions appeared last week after she spent some time outdoors gardening.
The lesions are not painful but are associated with mild itching. The patient says her skin is also fragile and
trivial trauma has caused superficial erosions that heal with scarring. She occasionally drinks alcohol but does
not use tobacco. The patient used injection drugs in the past but stopped after being diagnosed with hepatitis
C infection 8 years ago. She has not yet received treatment for hepatitis, and her only medication is a daily
oral contraceptive. Vital signs are within normal limits. Physical examination shows several vesicles and
erosions on the dorsum of both hands. Some of the lesions are healing with crusts and scars. Which of the
following is the most likely underlying cause of this patient’s skin lesions?
- O A. Allergen-induced delayed-type hypersensitivity
- O B. Bacterial invasion and superficial skin infection
- O C. Porphyrin accumulation due to impaired metabolism
- O D. Reactivation of latent virus in sensory ganglia
- O E. Subepidermal anti-transglutaminase lgA autoantibody
- O F. Vasculitis due to cryoglobulin immune complexes
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