Vesiculobullous and desquamating skin disorders Quiz: Ace Your Exams

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A 37-year-old woman comes to the office because of a rash on her elbows. The rash appeared three months ago and is intensely pruritic, often awakening her during sleep. She has tried multiple over-the-counter emollients and ointments with minimal improvement. A review of systems reveals mild abdominal pain and greasy, voluminous stools for the past year. The remainder of the history is noncontributory. Vitals are within normal limits. Physical examination shows groups of papules and vesicles on the elbows bilaterally as shown:  

A close up view shows a skin rash with many small, raised, red-purple bumps across a large area. The skin surface appears irritated and inflamed with a rough texture.
Reproduced from ">Wikimedia Commons  
Which of the following findings will be seen on direct immunofluorescence microscopy of biopsy specimens of these lesions?  

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