Pemphigus vulgaris (PV) is a rare immune-mediated blisteringdermatosis which is uncommon during pregnancy andgenerally presents with unhealing, painful, oral erosions1-5.However, transient or aphthous-like lesions are rarely presentin cases of PV and the condition may consequently bemisdiagnosed as recurrent aphthous stomatitis (RAS) orBeh?et’s disease (BD)2,3.A 34-year-old female at 23 weeks’ gestation presented witha 4-year history of RAS. She had previously been treatedfor RAS by means of oral hygiene practices, antiseptics,and topical corticosteroid, but her condition showed noimprovement and she continued to experience multiplepainful, recalcitrant, aphthous lesions. The patient had nohistory of erythema nodosum or arthralgia and her pathergytest was negative. Ophthalmological examination yieldednormal results. Dermatological examination revealed multipleirregular aphthous lesions without erythematous haloesacross the labial and buccal mucosa, and on the lateralborders and inferior surface of the tongue (Figure 1a). Thepatient also had a genital ulcer on the inner surface of thelabia minor (Figure 1b). Histopathological examination ofthe oral lesions revealed acantholysis in the bottom of thestratum spinosum, with the stratum basale cells of theepidermis remaining attached to the basement membrane,prompting a diagnosis of PV. Direct immunofluorescence(DIF) revealed intercellular deposits of IgG and C3. Enzymelinkedimmunosorbent assay (ELISA) detected desmoglein-3(Dsg3) and desmoglein-1 (Dsg1) at ?200, 1.28 RU mL.Indirect immunofluorescence (IIF) indicated increased cellsurface antibody titers at 1:120. The patient was treated withintralesional triamcinolone acetonide and topical steroids.
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