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Hypopyon sign in pemphigus vulgaris and pemphigus foliaceus

Case 1 A 32-year-old Indian woman presented with flaccid bullae which had been present for 1 year and a few lesions with hypopyon sign which had been present for 3 months. She initially developed multiple oral erosions over 3 months, followedbyflaccidbullaeover thechest, trunk,upperandlower limbs, face, scalp, and neck. The blisters ruptured in 2–3 days with subsequent peripheral extension. There were multiple, flaccid bullae and denuded areas with positive Nikolsky’s and bulla spread signs. Vesicles with hypopyon sign were present over the upper limbs, chest, and trunk (Fig. 1a). A clinical diagnosis of pemphigus vulgaris was made and the patient was started on 2.5 mg/kg/day prednisolone and 2 mg/kg/day azathioprine orally with other symptomatic treatment. Tzanck smear was positive for acantholytic cells. Gram’s stain of the pus from the lesions did not show any bacteria. An intact bulla was excised and histopathologic examination showed suprabasal clefting with occasional acantholytic cells within the cleft (Fig. 1b). The epidermis also showed spongiosis and neutrophilic infiltration. A moderate superficial perivascular mixed infiltrate of lymphocytes and neutrophils was seen in the dermis. Direct immunofluorescence (DIF) of