Pemphigus Vulgaris Mimicking Dyshidrotic Eczema: A Case Report

In this manuscript, we present a case of pemphigus vulgaris (PV) with unusual and rarely found clinical features and course. Primary pustular lesions forming annular arrangement made the current case challenging in terms of diagnostics. This case broadens the clinical spectrum of PV; therefore, we believe it is important from educative and medical point of view.

The study examined a patient with pemphigus lesions resembling dyshidrotic eczema initially located on the soles and on the scalp during the subsequent relapses. The final diagnosis of PV was based on histopathology, direct and indirect immunofluorescence (DIF, IIF), ELISA, and mycology. Histopathological examination showed the presence of suprabasal acantholysis and acantholytic cells. DIF and IIF revealed IgG in the epidermal intercellular spaces of the epidermis. Circulating IgG antibodies reacted with Dsg3 in ELISA. Mycology was negative. Though mild clinical features, the patient experienced two relapses and required higher doses of prednisone to achieve a remission.

PV may mimic dyshidrotic eczema. This is a rare case, in which non-obvious clinical picture made the diagnosis delayed. Numerous diagnostic procedures were required for the final PV diagnosis.