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Pemphigus presenting as oral ulcers refractory to acyclovir therapy
1Department of Medicine, Cooper Hospital/University Medical Center, Camden, NJ.
New Jersey Medicine : the Journal of the Medical Society of New Jersey
|September 1, 1993
Summary
Pemphigus, an autoimmune condition, can initially manifest as severe oral ulcers without skin lesions, delaying diagnosis. Early recognition of oral symptoms is crucial for timely pemphigus treatment.
Area of Science:
- Oral Medicine
- Dermatology
- Immunology
Background:
- Autoimmune blistering diseases pose diagnostic challenges.
- Pemphigus vulgaris is characterized by autoantibodies against desmogleins.
- Oromucosal involvement is a frequent initial presentation.
Observation:
- A patient presented with severe, persistent oral ulcerations.
- Initial presentation lacked cutaneous lesions, leading to a diagnostic delay.
- Acyclovir therapy for presumed viral etiology was ineffective.
Findings:
- Delayed diagnosis of pemphigus due to absence of skin lesions.
- Pemphigus commonly exhibits oral mucosal lesions preceding skin manifestations.
- Histopathological and immunofluorescence studies confirmed pemphigus.
Implications:
- Highlights the importance of considering pemphigus in refractory oral ulcerations.
- Emphasizes the need for thorough oral examination in autoimmune disease workups.
- Suggests earlier diagnostic consideration of pemphigus in cases of persistent oral ulcers, even without skin lesions.