45 yr old female admitted at my hospital with history of fever, lesions over lips oral cavity soft palate as shown in picture n some maculopapular rashes over trunk n upper limbs. she has microcytic hypochromic anaemia hb around 8. TC n platelets are normal. LFT RFT normal. ESR raised around 54. HIV negative. ANA awaited. Sugars are normal. No past history of any drug usage or any reaction. History of blood transfusion 2 months back that time Hb was around 6 (IDA was clinical impression that time.) we have a provisional diagnosis of Pemphigus Vulgaris. What's your opinion? what will be the best management options?



Dr Viral Patel Oral lesions can preceed body lesions in pemphigus vulgaris. Direct immunofluorescence should be done Just keep in mind a subset mucous membrane Pemphigoid and Paraneoplastic Pemphigus. Get help of a dermatologist, corticosteroids are the mainstay treatment. Immunosuppressants like azathioprine, Mycophenolate mofetil can be used but needs regular monitoring. For patients who are treated with systemic corticosteroids, calcium and vitamin D blood levels should be monitored and supplements given if needed to reduce steroid-induced osteoporosis. Furthermore, and especially in patients with pemphigus vulgaris, a baseline bone density test should be performed.

Wonderful and just awesome approach sir.

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pemphigus vulgaris. oral lesions following body lesions rx steroids orally in tapered manner & local application of folacin plus ointment. as steroids given calcium added for induced osteoporosis. .

Pemphigus vulgaris with leukoplakia, advised biopsy.

I agree with all my friends ' . It is pemphigis vulgaris

I agree with pemphigus vulgaris. The picture also leans towards erythematosus multiforme major/ SJS. Are the other mucus membranes involved as well? eyes, genitalia? You mentioned there is no drug history preceeding the event..so that rules out the latter.

I will straight away proceed for biopsy and await for results. I have not seen a case like this so no guesswork. thank you for showing a rare case.

Pemphigus vulgaris

Pemphigis the vulgaris

agreed its pemphigus vulgaris , biopsy n culture advised if duration is long, and add multivit and vit "C" inj. along with corticosteroids

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