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Rare Clinical Manifestation of Pemphigus Vulgaris in Elderly Patient : A Case Report and Brief Review

Pemphigus Vulgaris (PV) is a serious autoimmune disorder in the form of acute or chronic blisters on the mucocutaneous surface. The oral mucosa is the initial site of involvement in 50-60% of patients. Many known triggers have been associated with PV. This case report aims to describe a case of PV with an unusual clinical manifestation with multiple risk factors in elderly patient. A 78year-old woman came with a chief complaint of swelling on the lower lip for 3 months proceeded by oral ulcers on the lip vermillion. Extraoral examination showed diffuse swelling on the lower lip and a a cutaneous lesion on the right side of lower chin. Intraoral examination revealed ulcers and erosive lesion on the buccal mucosa. The medical history was rheumatoid arthritis treated with Dpenicillamine for 6 months. Working diagnosis of pemphigus vulgaris, acute pseudomembranous candidiasis, and angioedema were made. Several laboratory tests were performed. The anti-HSV-1 IgG test showed reactive. A tongue smear showed Gram-positive and -negative, and yeast. CBCT 3D examination showed inflammatory lesions, with the differential diagnosis includes malignant lesions, chronic osteomyelitis. Histopathological examination showed suprabasal acantholysis. A definitive diagnosis of PV was established. The patient was treated with acyclovir, corticosteroid, nystatin, chlorhexidine gluconate and multivitamin. Unusual clinical presentations challenging the early clinical diagnosis of PV in elderly patient with multiple risk factors. Hence, the appropriate laboratory test related to the risk factors is mandatory to provide the patient the adequate treatment. Case report (J Int Dent Med Res 2021; 14(3): 1144-1148)