Painful oral erosions revealing pemphigus vulgaris: rare clinical image

¹Department of Community Health Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher education and research, Wardha, Maharashtra, India

^&Corresponding author
Gaurav Mude, Department of Community Health Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher education and research, Wardha, Maharashtra, India

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A 45-year-old woman presented with a three-month history of painful oral ulcerations followed by progressive skin blistering. She reported difficulty eating and significant discomfort. Examination revealed multiple flaccid bullae over the trunk and scalp that ruptured easily, leaving erosions and crusted plaques. Oral examination showed irregular shallow erosions involving the buccal mucosa and soft palate. Gentle lateral pressure on perilesional skin induced epidermal detachment (positive Nikolsky sign). There was no history of recent drug intake. Histopathological examination of a skin biopsy demonstrated suprabasal acantholysis with a characteristic "row of tombstones" appearance. Direct immunofluorescence revealed intercellular IgG deposition within the epidermis, confirming pemphigus vulgaris. Pemphigus vulgaris is a potentially life-threatening autoimmune blistering disorder caused by antibodies against desmogleins, leading to loss of keratinocyte adhesion. Oral lesions often precede cutaneous involvement and may delay diagnosis. Early recognition, supported by histopathology and immunofluorescence, is crucial to initiate systemic corticosteroids and immunosuppressive therapy promptly, thereby preventing severe complications such as secondary infection and fluid-electrolyte imbalance.

Figure 1: multiple flaccid bullae and erosions over the trunk with positive Nikolsky sign