Diagnostic challenge: Epidermolysis bullosa acquisita of the palms and soles

Epidermolysis bullosa acquisita (EBA) is a rare autoimmune blistering disorder that can be difficult to diagnose, especially when its presentation mimics other blistering conditions. We present the case of a 56-year-old male who developed widespread blistering on flexural surfaces, palms, soles, and target lesions, with clinical features resembling bullous pemphigoid (BP), erythema multiforme (EM), and infectious aetiologies. A skin biopsy showed subepidermal bullae with linear IgG and C3 deposition at the basement membrane, with additional focal IgM and IgA positivity, and ELISA testing confirmed the presence of anti-collagen VII antibodies, diagnosing EBA. This case emphasizes the diagnostic challenge of atypical EBA presentations that overlap with BP and EM, highlighting the need to consider EBA in the differential diagnosis of blistering disorders.