A 22-year-old man presented with blisters on his lower legs. The lesions were pruritic but not painful. The patient had no other symptoms. On the previous day, he had been in the woods of northern Florida for more than 4 hours in wet conditions with temperatures around 80°F (26.7°C). He was wearing pants and high-ankle boots with socks. He first noticed the blisters that evening.

The patient was otherwise healthy and had no significant medical history. He recalled experiencing a similar but milder rash the previous year. Physical examination revealed large bullae on both legs from just above the malleoli to the midcalf area (Figure 1). A few lesions were also found at his waistline. The bullae ruptured and scabbed over 1 week after initial presentation (Figure 2).

QUESTION

Based on the patient’s history and physical examination, which one of the following is the most likely diagnosis?

• A. Bullous hypersensitivity reaction to arthropod bite.

• B. Bullous impetigo.

• C. Bullous pemphigoid.

• D. Bullous reaction to poison ivy.