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Coexisting pemphigus vulgaris and pemphigus foliaceus in the same patient

A 79-year-old man was admitted to our clinic with a 3-month history of diffuse scaly and bullous lesions. Skin examination revealed multiple blisters with an annular shape on the lower dorsum and abdominal areas (Fig. 1), while on the scalp and in the retroauricolar area lesions appeared as erythematous scales and crusts (Fig. 2). Symptoms referred were burning and itching. Past medical history of the patient revealed that he was affected by prostate cancer, treated with ormonal therapy. Chest X-ray and routine laboratory investigations were within normal limits. A TC scan and total body scintigraphy excluded distant metastasis. A paraneoplastic pemphigus was suspected and skin samples from scaly eythematous and bullous lesions were taken for histopathological examination and direct immunofluorescence. Indirect immunofluorescence on