ABSTRACT
Abstract A 73-year-old male patient developed a poorly differentiated squamous cell carcinoma in the anal canal nine months ago. He was treated with two cycles of 5-fluorouracil and cisplatin and concomitant radiotherapy (6 MeV linear photon accelerator, total dose of 54 Gy), with complete remission. Since forty-five days he presentes a painful perianal and intergluteal erosion with circinate pustular borders. Light microscopy showed pseudoepitheliomatous hyperplasia of the epidermis with microabscesses of inflammatory cells (neutrophils and eosinophils) and acantholytic keratinocytes . Indirect immunofluorescence was positive for IgG, with an intercellular pattern, 1:80 titer. The diagnosis of radiotherapy-induced pemphigus vegetans was established and there was significant regression with oral prednisone (40 mg) and topical betamethasone.
ABSTRACT
Pemphigus vegetans is a rare variant of pemphigus vulgaris and is characterized by vegetating lesions in the inguinal folds and mouth and by the presence of autoantibodies against desmoglein 3. Two clinical subtypes of pemphigus vegetans exist, which are initially characterized by flaccid bullae and erosions (the Neumann subtype) or pustules (the Hallopeau subtype). Both subtypes subsequently develop into hyperpigmented vegetative plaques with pustules and hypertrophic granulation tissue at the periphery of the lesions. Oral administration of corticosteroids alone does not always induce disease remission in patients with pemphigus vegetans. We report here on a 63-year-old woman with pemphigs vegetans. She had a 2-year history of vegetating, papillomatous plaques on the inguinal folds and erosions of the oral mucosa. The enzyme-linked immunosorbent assay was positive for anti-desmoglein 3, but it was negative for anti-desmoglein 1. She was initially treated with systemic steroid, but no improvement was observed. The patient was then successfully treated with a combination of systemic steroid and dapsone with a good clinical response.
Subject(s)
Female , Humans , Middle Aged , Administration, Oral , Adrenal Cortex Hormones , Autoantibodies , Blister , Dapsone , Desmoglein 3 , Enzyme-Linked Immunosorbent Assay , Granulation Tissue , Mouth , Mouth Mucosa , PemphigusABSTRACT
Pemphigus vegetans is a rare variant of pemphigus vulgaris characterized by vegetating plaques in the flexural regions. The coexistence of pemphigus vegetans and internal neoplasm is rare, being described only in four cases in the literature. We report the case of a patient with a typical skin eruption of pemphigus vegetans, who was detected with colonic cancer.
ABSTRACT
Pemphigus foliaceus is a rare, relatively mild and chronic variety of pemphigus which is characterized by superficial flaccid bullae which show acantholytic changes in the upper part of the epidermis histopathologically. Present case is a 40-year-old female with a 2 month history of yellowish colored verrucous plaques on the whole scalp. 6 years ago, she had been admitted to our hospital because of nearly generalized erythematous eroded patches, crusted plaques and bullae and diagnosed as pemphigus foliaceus and treated with corticosteroid and methotrexate. 2 months ago, an additional lesion was found on the scalp, where yellowish colored, verrucous surfaced plaques were observed. Histologic examination on the verrucous plaque showed hyperkeratosis, acanthosis and papillomatosis with acantholysis in the granular layer, leading to a subcorneal blister and dyskeratotic granular keratinocytes were seen within the blister. On the basis of clinicopathologic examination we diagnosed as pemphigus foliaceus and then we treated her with prednisolone and the skin lesion had subsided 7 months later. We report a patient of pemphigus foliaceus who was presented with verrucous surfaced plaque, which clinically mimicked pemphigus vegetans.
Subject(s)
Adult , Female , Humans , Acantholysis , Blister , Cytochrome P-450 CYP1A1 , Epidermis , Keratinocytes , Methotrexate , Papilloma , Pemphigus , Prednisolone , Scalp , SkinABSTRACT
We experienced a 40-year-old female patient who had vegetating plaques, erosions and a few vesicles on the external genitalia and the oral mucasa, assoeiated with pulmonary tuberculosis. On the skin biopsy specimen of the vegetating plaque, it showed acanthoais, papillomatosis, downward proliferation of the epidermis and eosinophilic microabacess in the epidermis. Direct immunofluorescence of the perilesional skin revealed deposition of IgG, Cq, Cs and C on the intercellular substance of the epidermis. Indirect immunofluorescence disclosed IgCi auto antibody(1: 320) positive to the inter ellular substance of the normal human back skin. The skin lesion had impraved with dapsone therapy.
Subject(s)
Adult , Female , Humans , Biopsy , Dapsone , Eosinophils , Epidermis , Fluorescent Antibody Technique, Direct , Fluorescent Antibody Technique, Indirect , Genitalia , Immunoglobulin G , Papilloma , Pemphigus , Skin , Tuberculosis, PulmonaryABSTRACT
We experienced a 54-year-old female patient who had multiple vegetaing plaques and, peripherally, a few pustules in her both axillae. On the skin biopsy specimen of the vegetating plaque, it showed acanthosis, suprabasal acsntholysis, papillo-matosis, downward proliferation of the epidermis, and eosinophilic microroabscess in the epidermis. The indirect immunofluorescence study disclosed anto-antibody positive to intercellular substance of the lip of guinea pig, while direct. immuno-fluorescence of the perilesional skin reealed no specific findings. The skin lesion had improved with topical and systemic steroid therapy.