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Case Reports
. 2018 Nov-Dec;22(6):551-554.
doi: 10.4103/jisp.jisp_345_18.

Oral pemphigus without skin lesions treated with pulse steroid therapy

Nitya Kala  1 , Jayakumar Manjeu  1 , Neil Dominic  2 , Srinivasan Poovan Kirubanidhi Kennedy Babu  1
Affiliations
Case Reports

Oral pemphigus without skin lesions treated with pulse steroid therapy

Nitya Kala et al. J Indian Soc Periodontol. 2018 Nov-Dec.

Abstract

Pemphigus is an autoimmune disease affecting the skin and mucosae. Oral lesions are common and sometimes are the only manifestations of the disease. The clinical presentations of pemphigus might mimic other vesiculobullous lesions of the oral cavity. We report a case of a 60-year-old male patient who complained of erosive lesions in the oral cavity. The lesions were diagnosed as pemphigus based on histopathological examination and immunofluorescence findings. The patient did not respond to topical steroids and low doses of systemic steroids. Since the patient began developing dermatological manifestations, he was administered pulse steroid therapy. He is currently under observation and his clinical signs and symptoms show improvement, although he has developed hyperglycemia as a complication.

Keywords: Autoimmune disease; immunofluorescence; oral pemphigus; pulse steroid therapy; vesiculobullous disease.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Oral lesions during the patient's first clinical visit showing erosive lesions on the buccal mucosa, palate, gingiva, and alveolar mucosa
Figure 2
Figure 2
Histopathological examination showed the basal layer of epithelial cells (red arrowheads) separated from the rest of the epithelium by a cleft-like space (black asterisks) (H and E, ×200)
Figure 3
Figure 3
Freely floating Tzanck cells (red arrowheads) along with red blood cells, visible in the cleft-like spaces (H and E, ×400)
Figure 4
Figure 4
Direct immunofluorescence with IgG shows a typical fishnet type of positive fluorescence, along the intercellular junctions (white arrowheads) of the epithelium
Figure 5
Figure 5
Oral lesions showed marked improvement following two courses of Phase I of the pulse steroid therapy
See this image and copyright information in PMC

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