When the Skin Tells Another Story: Incidental Epidermolysis Bullosa in an Adult Hospitalized for Chronic Respiratory Symptoms.

Epidermolysis bullosa (EB) comprises a heterogeneous group of inherited blistering disorders characterized by skin fragility and trauma-induced blister formation. Although EB is typically recognized in childhood, milder phenotypes may remain underdiagnosed in adults and may be identified incidentally during evaluation for unrelated medical conditions. A 47-year-old man was admitted for chronic respiratory symptoms and a history of prior granulomatous infections. During a routine physical examination, extensive chronic blistering skin lesions were identified incidentally. Inpatient evaluation ruled out reactivation of pulmonary tuberculosis, pneumonia, and coccidioidomycosis, with chest computed tomography demonstrating only residual apical fibrosis. Dermatologic evaluation raised suspicion for EB. Subsequent outpatient skin biopsy revealed a subepidermal blister with minimal inflammatory infiltrate compatible with EB. This case highlights the diagnostic value of comprehensive physical examination and emphasizes the importance of multidisciplinary evaluation when rare dermatologic conditions are encountered in adult inpatients.