[Anesthesia for a patient with pemphigus erythematosus]

An 82-year-old female with pemphigus erythematosus had the head of femur replaced. In her case, systemic lupus erythematosus and myasthenia gravis, typical complications of pemphigus erythematosus, were not present. As even slight friction easily causes blisters in patients with pemphigus, we paid attention mainly to fragility of the skin and the mucus membranes and were careful to minimize physical stimulation of the skin. Because the mucosa of the pharynx or oral cavity could easily be damaged and form blisters during intubation, which in turn might make the management of the upper airway more difficult, we selected spinal anesthesia. No serious perioperative complications, except a few blisters around the wound were observed. We thus successfully managed anesthesia of a patient with pemphigus erythematosa.