Oral Manifestations of Pemphigus Vulgaris

A previously healthy 44-year-old woman presented with mouth ulcers and blistered lips persisting for 11 months, causing pain while eating and unintentional weight loss. She also reported skin blisters on her arms and legs over the past six months.

On physical examination, the lips were swollen with bleeding erosions and pustules. Additional erosions were observed on the hard palate, tongue, buccal mucosa, and floor of the mouth, along with gingivitis and halitosis. Skin examination revealed flaccid bullae and blisters.

A gingival biopsy showed intraepithelial separation with basal cell retention along the basement membrane. Direct immunofluorescence demonstrated IgG deposition in epithelial-cell membranes, forming a characteristic "chicken wire" pattern—confirming pemphigus vulgaris, an autoimmune blistering disorder.

The patient was referred to dermatology and treated with prednisone, steroid-sparing immunosuppressants, and rituximab. Six months after therapy initiation, all oral lesions had resolved.

A previously healthy 44-year-old woman presented with mouth ulcers and blistered lips persisting for 11 months, causing pain while eating and unintentional weight loss. She also reported skin blisters on her arms and legs over the past six months.

On physical examination, the lips were swollen with bleeding erosions and pustules. Additional erosions were observed on the hard palate, tongue, buccal mucosa, and floor of the mouth, along with gingivitis and halitosis. Skin examination revealed flaccid bullae and blisters.

A gingival biopsy showed intraepithelial separation with basal cell retention along the basement membrane. Direct immunofluorescence demonstrated IgG deposition in epithelial-cell membranes, forming a characteristic "chicken wire" pattern—confirming pemphigus vulgaris, an autoimmune blistering disorder.

The patient was referred to dermatology and treated with prednisone, steroid-sparing immunosuppressants, and rituximab. Six months after therapy initiation, all oral lesions had resolved.