Pemphigus Foliaceus: A Rare Case of Exfoliative Dermatitis

Abstract

A 51-year-old female, diagnosed case of Pemphigus foliaceous in 2019 and was previously admitted in this institution and was given topical and systemic corticosteroids with tapered dosing of Prednisone prior to being lost to follow-up. One month prior, patient was brought in for consult due to multiple bullae and erythematous, well-defined plaques with whitish scaling and erosions on the face, anterior trunk and extremities associated with pain and burning sensation. Laboratory work up was requested with non-contributory findings. Skin punch biopsy was done which revealed intraepidermal blister with few acantholytic cells, suggestive of Pemphigus Foliaceous. Direct immunofluorescence was also done which showed deposit of immunoglobulin G and C3 in the superficial intercellular space. Hence, a final diagnosis of exfoliative dermatitis (ED) secondary to PF was considered. She was started with topical corticosteroids on affected areas which she applied for a few weeks. However, patient was lost to follow up. One week prior, persistence of the lesions with associated chills, pain and tenderness prompted consultation and was subsequently admitted. Cutaneous examination revealed generalized erythema with overlying scales moist crusts and erosions involving over 90% of the body surface area, over the face trunk and extremities. No oral lesions appreciated. There were few areas of sparing over the legs. Nikolsky sign was positive. Patient was started on prednisone 70mg/day (1mkD) and was gradually tapered at 1.5mkD, and azathioprine 100mg/day(1.5mkD) along with topical corticosteroids. In summary, she was managed with systemic corticosteroids initially and later with the addition of azathioprine. She responded although very slowly and complete remission was attained in 5 months.