Endoscopic Findings of Mucosal Pemphigus Vulgaris: Clinical Correlation and Diagnostic Value

Pemphigus vulgaris (PV) is an autoimmune bullous disease that usually starts on the oral mucosa, but it can affect all mucosal surfaces. There are limited data about endoscopic otorhinolaryngological examination of patients with PV.

To assess the prevalence of nasal, pharyngeal, and laryngeal involvement in patients with PV and to determine its correlation with clinical symptoms.

Thirty-four patients with pemphigus vulgaris were questioned for rhinorrhea, epistaxis, hoarseness, and throat pain. All patients' nasal, oral, hypopharyngeal, and laryngeal mucosa were then examined endoscopically by the same otolaryngologist, and mucosal lesion localizations were noted. The association between symptoms and lesion localization was assessed using the chi-squared test.

The study included 34 patients, 14 (41.2%) males and 20 (58.8%) females; 32 (94.1%) patients had oral mucosal involvement. Nasal, hypopharyngeal, and laryngeal involvement were detected in 52.9%, 58.8%, and 55.9% of cases, respectively. Endoscopic examination revealed lesions in areas other than the oral mucosa in 30 patients, with 24 (70.6%) exhibiting symptoms related to these regions. Nasal bleeding was a significant symptom of nasal involvement (P=0.006), whereas nasal obstruction was not (P=0.388). Throat pain was significantly associated with hypopharyngeal involvement (P=0.003), while hoarseness showed marginal significance (P=0.05). No significant association was found between laryngeal or tonsillar involvement and any symptom.

The study demonstrates that a significant proportion of pemphigus vulgaris patients have silent mucosal involvement. This suggests that symptom-based evaluations may be insufficient and that systematic endoscopic screening could play a critical role in PV management.