Refractory pemphigus vulgaris in a military aviator

Pemphigus vulgaris is a rare, chronic autoimmune blistering disease of the skin and mucous membranes that if untreated can be fatal. Current treatment regimens use high-dose systemic steroids to reduce the production of autoantibodies and adjuvant immunosuppressives to compliment and reduce the need for steroids. The disease itself and the pharmacotherapy that makes up the mainstay of treatment present the potential to cause significant disability in aviation personnel. This case report describes the 8-yr treatment course of a military aviator from initial diagnosis to treatment and the achievement of an asymptomatic state nearing stable remission. The discussion addresses the aeromedical implications of the disease itself, side effects of commonly used therapeutic medications, and operational implications on military aviators.