Bilateral herpes simplex virus keratitis in a patient with pemphigus vulgaris

Pemphigus is a group of chronic blistering diseases in which acantholysis and blister formation occur within the epidermis. Immunoglobulins and complement are found in the circulation and are bound to the cell surfaces of keratinocytes. Pemphigus is classified into several types but may be divided into two major variants, pemphigus vulgaris and pemphigus foliaceus. The primary skin lesion of pemphigus vulgaris which was often fatal before the introduction of systemic glucocorticoid therapy, is a flaccid, fragile blister which can occur anywhere. The most common skin lesions are erosions, which are often painful; suprabasal clefting within the epidermis is also present. In the majority of these patients, painful mucous membrane erosions will be the first symptom, while sometimes the conjunctiva is affected but corneal involvement is very rare. There are few reports of herpes simplex keratitis occurring with a blistering disease. This is a case report of bilateral herpes simplex virus keratitis superinfection during the glucocorticoid treatment of pemphigus vulgaris.