Oral Lesion Case Study Summary: Pemphigus Vulgaris

Presented by Kyla Mumford

Course: DEN 222 General and Oral Pathology

Date: March 3, 2025

Summary of the Condition/Lesion

• Definition: Chronic autoimmune vesiculo-bullous disease causing blistering lesions of skin and mucous membranes.
• Etiology:
  • Autoantibodies attach to desmosomes, preventing cell bonding, leading to blistering.
  • Multifactorial disease with unknown specific cause; potential genetic predisposition.
  • Associated with certain human leukocyte antigens (HLA): A10, A26, Bw28, DR24.
  • Caused by binding of IgG antibodies to desmoglein 3 and 1.
• Demographics and Prevalence:
  • Common in Ashkenazi Jewish, Mediterranean descent, India, Southeast Europe, Middle East.
  • Equal occurrence in males and females; higher incidence in ages 40-60.
• Clinical Presentation:
  • Lesions affect oral mucosa first and are painful.
  • Bullae rupture to form ulcers with a gray pseudomembrane.
  • Positive Nikolsky sign: bulla forms by rubbing mucosa.
  • Common oral sites: buccal mucosa, tongue, palate, lower lip.
  • No radiographic characteristics.
• Diagnosis:
  • Biopsy and direct immunofluorescence test.
  • Histopathologic evaluation showing acantholysis and Tzanck cells.
• Treatment and Management:
  • Systemic corticosteroids and immunosuppressive agents.
  • Importance of oral hygiene, avoid abrasive substances.
  • Monitor diet: nutritious, soft foods, avoid irritants.
  • Monitor for treatment side effects, involve a healthcare team.
• Prognosis:
  • Early treatment crucial: reduces mortality from 60-80% to 5-10%.

Journal Case Study Summary

• Patient Profile:
  • 40-year-old male from Karwar, Karnataka, India.
  • Chief complaints: oral ulcers, dysphagia over 20 days.
  • Poor oral hygiene, history of tobacco, alcohol use.
• Clinical Findings:
  • Bilateral palpable submandibular lymph nodes.
  • Ulcerative lesions with pseudomembrane, positive Nikolsky's sign.
  • Lesions on buccal mucosa, tongue, palate, oropharynx.
  • Generalized attrition, gingival inflammation, bleeding on probing.
• Treatment Regimen:
  • Prednisolone 60 mg/day, topical analgesic mouthwash, Triamcinolone ointment.
  • Reduction in symptoms observed by third follow-up with 90% healing.
• Outcome:
  • Early diagnosis and treatment led to remission and positive prognosis.

Critique of the Case Study

• Weaknesses:
  • Lack of discussion on systemic effects of medication and long-term prognosis.
  • Insufficient detail on differential diagnosis.
• Strengths:
  • Detailed lesion description, consistent with other studies.
  • Clear and easy-to-follow study, though microscopic analysis challenging.
• Additional Notes:
  • No radiographs needed, effective use of intraoral photographs to aid diagnosis.

References

1. Arpita R, Monica A, Venkatesh N. Oral Pemphigus Vulgaris: Case Report. Ethiop J Health Sci, 2015.
2. Ingold C, Sathe N, Khan M. Pemphigus Vulgaris. StatPearls Publishing, 2025.
3. Subadra K, Sathasivasubramanian S, Warrier S. Oral Pemphigus Vulgaris, 2021.
4. Delong L, Burkhart NW. Lesions That Have a Vesicular Appearance, 2019.