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Technique of Conjunctival Biopsy and Direct Immunofluorescence for Diagnosing Mucous Membrane Pemphigoid
Published on: June 17, 2025
Two distinct viral infections complicating pemphigus foliaceus
Sarah N Gee1, Nicole F Velez, Alireza Sepehr
1Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Dermatology Online Journal
|February 4, 2012
Summary
An 83-year-old female with pemphigus foliaceus developed disseminated herpes simplex virus (HSV) and cytomegalovirus (CMV) infections. Early consideration of viral infections is crucial for patients with autoimmune bullous diseases.
Area of Science:
- Dermatology
- Infectious Diseases
- Immunology
Background:
- Pemphigus foliaceus is an autoimmune blistering disease.
- Corticosteroid treatment is common for pemphigus foliaceus.
- Immunosuppression increases susceptibility to infections.
Observation:
- An 83-year-old female with pemphigus foliaceus presented with painful ulcerations.
- Initial histopathology revealed disseminated herpes simplex virus (HSV).
- Despite antiviral treatment, some lesions persisted, leading to a second biopsy.
Findings:
- The second biopsy identified concurrent cytomegalovirus (CMV) infection.
- Both HSV and CMV infections were successfully treated with antiviral therapy.
- This case highlights the potential for multiple, distinct viral infections in immunocompromised patients.
Implications:
- Clinicians should suspect concurrent cutaneous viral infections in autoimmune bullous disease patients with new or worsening symptoms.
- Prompt ancillary testing, re-biopsy, and consideration of empiric antiviral treatment are recommended.
- Modification of immunosuppressive regimens may be necessary in severe cases.
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