Role of neutrophil-to-lymphocyte, neutrophil-to-eosinophil and platelet-to-lymphocyte ratios in the diagnosis of bullous pemphigoid and Pemphigus disease

Context: Bullous pemphigoid (BP) and “Pemphigus diseases” (PD) can have overlapping clinical manifestations and accurate distinction is crucial for appropriate management. Aims: The study aimed at analyzing the utility of simple hematological markers of systemic inflammation like neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-eosinophil ratio (NER), and platelet-to-lymphocyte ratio (PLR) in clinical decision making in the setting of clinical differentials of BP and PD in a particular case. Methods: This single-centre based retrospective observational analytical study included adult subjects newly diagnosed to have BP (n=66) or PD (n=53), confirmed with direct immune-fluorescence testing, over a period of six years. Blood counts performed using Coulter™ hematology analyser, at the time of their initial presentation, were retrieved from the hospital medical records, and the leucocyte ratios were calculated.Statistical Analysis: The data were compared between the two groups, using Mann–Whitney U test and chi-square test /Fisher's exact test. ROC curve analysis was performed to estimate cut-off values. Results: The BP group had a significantly higher NLR, total leukocyte counts (TLC), absolute eosinophil counts (AEC), and absolute lymphocyte counts (ALC), and lower NER values compared to the PD group (P < 0.05). Areas under ROC for NLR, NER, TLC, AEC, and ALC were between 0.5 and 0.7. NLR ? 7, AEC ? 2055/cumm, and TLC ? 15,000/cumm had a specificity of 90.6, 100, and 100% respectively for identifying BP patients out of the two groups, but with a low sensitivity of 22.7, 21, and 22.7%, respectively. Conclusions: NLR can be a valuable diagnostic adjunct in subtyping autoimmune bullous disorders, albeit in a small proportion of cases.

Incidence of infections in patients with pemphigus vulgaris

Background:Pemphigus is a rare, chronic autoimmune blistering disease of skin and mucous membranes. Autoimmune process and immunosuppressive therapy of pemphigus vulgaris would predispose the patients to infections. Therefore, the objective of this study was to isolate and identify the pathogens in admitted patients suffering from pemphigus vulgaris.Methods:This was a retrospective observational study based on 68 diagnosed cases of pemphigus vulgaris (PV) admitted during January1999 to April 2018 in SRN hospital, MLN medical college Prayagraj. Patients who had PV and required admission owing to development of severe symptoms were included while patients with mild symptoms were excluded from the study. These admitted patients, along with routine and radiological examination, were also examined for microbiological examinations of sputum, throat swab, blood, body fluids, skin scrapings, stool and urine when necessary.Results:Out of the 68 patients, 66.17% patients developed bacterial infections while 33.83% developed fungal infections. The prevalence of bacterial and fungal pathogens in urinary tract is 72.42% and 27.58%, pneumonitis is 29.42% and 70.58%, septicaemia is 81.82% and 18.18% and skin and soft tissue is 87.50% and 12.50% respectively. In meningitis and pulmonary tuberculosis no traces of fungi were recorded. Mortality was seen in 7.35% patients, which wasdue to bacterial meningitis, septicaemia and fungal pneumonitis.Conclusions:The present study clearly states that the occurrence of the disease is uncommon but secondary infections are associated with worse prognosis. Therefore, the best regimen for each type of patients should base on the extent of disease and patient’s comorbidities.

Severe visceral leishmaniasis and COVID-19 coinfection in an immunosuppressed patient

ABSTRACT Visceral leishmaniasis (VL) is an opportunistic disease in immunosuppressed individuals, who may present severe clinical conditions, such as the ones described in this patient. She lived in an endemic region for VL, and was possibly infected with L. (L.) infantum chagasi through the bite of a contaminated sand fly. This initial infection has triggered a pemphigus vulgaris condition by immunogenic proteins present in the mosquito's saliva. The immunosuppression caused by the use of high doses of corticosteroids to control the disease promoted a severe VL condition, with hepatosplenomegaly, thrombocytopenia and hemorrhages, requiring hospitalization and the onset of a subsequent SARS-CoV-2 infection. Due to the intensity of clinical manifestations related to VL, aggravated by COVID-19, she died two days after admission to the Clinical Hospital of Marilia Medical School (HC-Famema).

Desquamative Gingivitis as the First Clinical Sign of Pemphigus Vulgaris: A Case Report

ABSTRACT@#Desquamative gingivitis is characterised by desquamation of the gingiva with painful erosion and ulceration. It is predominantly a manifestation of several vesiculobullous diseases. Delayed diagnosis or misdiagnosis often led to disease progression. Pemphigus vulgaris is a chronic, life-threatening autoimmune disease resulting in blistering of the mucosa and skin. Oral lesions normally preceded skin lesions. Early diagnosis and treatment are important to prevent involvement of the skin, as the treatment and prognosis varies with extraoral involvement. Clinical, histopathological examination and direct immunofluorescent are necessary for the diagnosis of pemphigus vulgaris. Treatment of desquamative gingivitis involves improving oral hygiene, reduce irritation to the lesions and specific therapy to the underlying disease. This paper describes a case of a patient with desquamative gingivitis for one year, whom is ultimately diagnosed as having pemphigus vulgaris.

Experience in the diagnosis and treatment of a drug-induced pemphigus / 华西口腔医学杂志

Drug-induced pemphigus (DIP) is a special type of pemphigus, and its pathogenesis, characteristics of treatment, and prognosis are closely related to the inducing drugs. This article reports the diagnosis and treatment of DIP (pemphigus vulgaris) caused by the administration of rifampin to a patient with tuberculosis. Combined with the literature, we discussed the types, pathogenesis, differential diagnosis, and treatment principles of DIP. We propose that in the oral clinical practice for patients with pemphigus vulgaris, the importance of investigating suspected drugs that induce DIP should be emphasized.

Naturopathy and Yoga for improving quality of life in Pemphigus vulgaris and managing co-morbid type 2 diabetes: A case report

A 57 years old male patient was admitted to an inpatient Naturopathy and Yoga (N&Y) hospital, diagnosed with pemphigus vulgaris (PV) for one year and co-morbid type 2 diabetes (T2DM) for 10 years,associated with poor quality of life (QoL). He was administered N&Y therapies for 10 days, along withconventional medicines. There was improved QoL and reduced dosage of insulin, along with reduction inbody weight. These changes were sustained and improved further during the 60-day follow-up period.Although there was no improvement in the skin lesions, the improvement in QoL indicate a possible roleof N&Y in management of PV and T2DM. This case report also warrants further studies for N&Y in themanagement of dermatological conditions as well as metabolic syndrome.© 2020 The Authors. Published by Elsevier B.V. on behalf of Institute of Transdisciplinary Health Sciencesand Technology and World Ayurveda Foundation. This is an open access article under the CC BY-NC-NDlicense (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Pénfigo vulgar refractario a tratamientos convencionales, con respuesta positiva a Rituximab: presentación de 5 casos / Positive Outcome in Treatment of Patients with Pemphigus Vulgaris Refractory to Conventional Treatments: A Report of Five Cases

Resumen El pénfigo vulgar es una enfermedad ampollar crónica de etiología autoinmune, en la cual el diagnóstico y tratamiento precoz disminuye la morbimortalidad de los pacientes. Actualmente se utilizan corticosteroides de primera línea asociados a inmunosupresores. Sin embargo,se ha visto que el uso de Rituximab como terapéutica de primera elección en los países desarrollados ha disminuido las reacciones adversas, con lo que mejora la calidad de vida de los pacientes. Se presentan cinco pacientes con diagnóstico de pénfigo vulgar refractario a tratamientos convencionalesque requirieron tratamiento con Rituximab.

Abstract Pemphigus vulgaris is an autoimmune chronic blistering disease. Its early diagnosis and treatment help reduce patient mortality and morbidity. Corticosteroids associated with immunosuppressants remain the standard treatment for pemphigus vulgaris. However, the use of Rituximab as first-line therapy in developed countries has been effective in reducing adverse effects improving the quality of life of patients. We report five patients with a diagnosis of pemphigus vulgaris refractory to conventional treatments requiring treatment with Rituximab.

Pénfigo vulgar / Pemphigus vulgaris

Resumen: El pénfigo es una enfermedad autoinmunitaria y crónica de incidencia y prevalencia bajas; sin embargo, puede alcanzar mortalidad de incluso 75% sin tratamiento. Existen dos variedades principales: el pénfigo vulgar y el foliáceo, que en términos clínicos se distinguen por la aparición de ampollas en la piel, con afección de las mucosas en los pacientes con pénfigo vulgar. En esta revisión se detalla la epidemiología, causas, fisiopatología y tratamiento de esta enfermedad, con insistencia en la importancia de los esteroides como piedra angular del tratamiento de estos pacientes.

Abstract: Pemphigus is an autoimmune and chronic disease with low incidence and preva- lence. Nevertheless it could reach a 75% mortality rate without treatment. There are two principal types: vulgar pemphigus and foliaceus pemphigus, which are clinically characterized by skin blister appearance, with mucosal affection in patients with pemphigus vulgaris. This review details the epidemiology, etiology, physiopathology and treatment of this disease, remarking the steroid importance as the cornerstone in the management of these patients.

Úlcera corneal bilateral en un anciano con pénfigo vulgar / Bilateral corneal ulcer in an old man with pemphigus vulgaris

Se describe el caso clínico de un paciente de 72 años de edad, con diagnóstico de pénfigo vulgar, quien fue asistido en la consulta de Oftalmología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba porque padecía enrojecimiento ocular, unido a disminución de la visión y secreciones abundantes de aproximadamente 5 días de evolución. En el examen oftalmológico se confirmó la presencia de úlcera corneal bilateral por perforación infecciosa. Se indicó tratamiento con colirios de antibióticos (ceftazidima y amikacina), antiinflamatorio no esteroideo, agentes antihipertensivos y lente de contacto, con lo cual mejoraron las lesiones de ambos ojos. El proceso infeccioso pudo deberse a cierta susceptibilidad a los esteroides e inmunosupresores sistémicos, como terapia asociada al pénfigo vulgar, o al mecanismo autoinmune característico de esta dermatopatía.

The case report of a 72 years patient is described, with diagnosis of pemphigus vulgaris who went to the Ophthalmology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba because he suffered from ocular redness, together with a decrease vision and abundant secretions of approximately 5 days of history. In the ophthalmological examination the presence of bilateral corneal ulcer was confirmed due to infectious perforation. Treatment was indicated with antibiotic eyewashes (ceftazidime and amikacine), non esteroidal anti-inflammatory drugs, antihypertensive agents and contact lens, with which the injuries of both eyes improved. The infectious process could be due to certain susceptibility to the steroids and systemic inmunosupressors, as therapy associated with pemphigus vulgaris, or to the autoinmune mechanism characterizing this dermatopathy.

A Rare Case of Juvenile Pemphigus Vulgaris Treated with Intravenous Immunoglobulin / 대한피부과학회지

Juvenile pemphigus vulgaris (JPV) is a rare variant of pemphigus vulgaris (PV) occurring in childhood and adolescence that has similar symptoms and the same histological and immunopathological features as classic adult PV. Although rare, advanced cases of JPV can be fatal due to secondary sepsis. Many patients with JPV are misdiagnosed and therefore not properly treated in the early stages of the disease. Although systemic corticosteroids are the therapeutic mainstay, long-term corticosteroid use has various adverse effects. Intravenous immunoglobulin (IVIG) was recently reported to reduce the side effects of corticosteroids. Here, we report a case of JPV in a 14-year-old boy treated with IVIG.

Concurrent Bullous Pemphigoid and Pemphigus Vulgaris / 대한피부과학회지

No abstract available.

Pénfigo vulgar en pediatría a propósito de un caso / Pemphigus vulgaris in pediatrics: a case report

Resumen: Introducción: El pénfigo vulgar es una enfermedad grave y poco frecuente en niños. Su diagnóstico y tratamiento oportuno permite modificar el pronóstico. El objetivo es describir las características clínicas y el abordaje diagnóstico y terapéutico de esta poco frecuente enfermedad vesículo-ampollar autoinmune en niños. Caso clínico: Niño de 2 años, previamente sano. Comenzó con dermato sis generalizada con máximo lesional en región umbilical, miembros y genitales, caracterizada por ampollas, algunas denudadas con sangrado fácil, sin compromiso mucoso ni fiebre. Se diagnosticó impétigo bulloso y se indicó antibioticoterapia tópica y sistémica sin mejoría clínica. Evolucionó con extensión lesional, con compromiso de mucosas oral y anal. El estudio histológico e inmunohistoquí- mico de las lesiones y la piel perilesional confirmó pénfigo vulgar. Se inició tratamiento corticoideo e inmunomodulador con buena respuesta. Conclusiones: Dada la similitud de las manifestaciones del pénfigo vulgar con otras enfermedades infecciosas e inflamatorias de mayor prevalencia, se requiere un alto índice de sospecha para evitar demoras en el diagnóstico y el comienzo del tratamiento. En pacientes con manifestaciones vesículo ampollares de evolución no esperada, es necesaria la intercon sulta por dermatólogo y evaluar la oportunidad de biopsia de la lesión y piel perilesional, para estudio histológico e inmunofluorescencia directa, lo que permitirá la confirmación diagnóstica.

Abstract: Introduction: pemphigus vulgaris is a serious and infrequent disease in children. Its timely diagnosis and treatment allows modifying its prognosis. The objective is to describe its clinical characteristics, and the diagnostic and therapeutic approach of this uncommon autoimmune blistering disease in children. Clinical case: 2-year-old male patient, previously healthy. He initially presented generalized dermatosis with maximum lesion areas at the umbilical region, limbs and genitals; characterized by blisters, some denuded, and of easy bleeding, without mucosal involvement nor fever. Bullous im petigo was diagnosed and topical and systemic antibiotic treatment was started, showing no clinical improvement. He developed extension of the lesions with oral and anal mucosal involvement. The histologic and direct immunofluorescent study of lesions and perilesional skin confirm the diagnosis of pemphigus vulgaris. The patient started treatment with corticosteroids and immunomodulatory agents with good clinical response. Conclusions: Due to the similarity with other more prevalent infectious and inflammatory diseases, a high index of suspicion is required in order to avoid delays in the diagnosis and the start of treatment. In patients with blisters with an unexpected clinical evolu tion, it is necessary to conduct a joint evaluation with a dermatologist and to assess the opportunity of performing a biopsy of the lesion and perilesional skin for histological study and direct immunofluo rescence, which will allow diagnostic confirmation.

Association between human leukocyte antigen-DRB1 and human leukocyte antigen-DQB1 alleles and pemphigus vulgaris in Indian patients: A case–control study

Background: HLA-DRB1*04, -DRB1*08, -DRB1*14, -DQB1*03 and -DQB1*05 are reported to have significant association with pemphigus vulgaris; however, this is partially dependent on ethnicity. This study was done to determine the HLA-DR and -DQ types prevalent in Indian patients with pemphigus vulgaris. Methods: A prospective case–control study was done for a period of 9 months in Christian Medical College Vellore, India. HLA typing was done by PCR-SSOP method in 50 cases and 50 healthy controls. Allele frequencies in cases and controls were compared and odds ratios with 95% confidence interval were calculated. Results: The mean age of the patients (29 females, 21 males) and that of controls (36 males, 14 females) were 41.3 ± 13.65 and 35.42 ± 11.09 years, respectively. HLA-DRB1*14 was present in 47 patients and 18 controls (OR, 27.85; 95% CI, 7.57–102.42) and HLA-DQB1*05 was seen in 47 patients and 24 controls (OR, 16.97; 95% CI, 4.66–61.80). The haplotype DRB1*14, DQB1*05 was present in 44 patients and 14 controls (OR, 18.86; 95% CI, 6.58–54.05). DRB1*15 was present in 7 cases and 16 controls (OR, 0.35; 95% CI, 0.13–0.94) and DQB1*06 was present in 8 cases and 19 controls (OR, 0.31; 95% CI, 0.12–0.80). HLA-DQB1*03 was associated with significantly higher pemphigus disease area index scores. Limitations: The main limitations were that the numbers studied were small as the study was conducted at a single center, and the haplotype analysis was limited only to the proband. PDAI scores could have been influenced by prior treatment. Conclusion: There was a significant association between HLA-DRB1*14 and HLA-DQB1*05 and pemphigus vulgaris in our patients. A negative association was seen with DRB1*15 and DQB1*06.

Curative effect of ozone hydrotherapy for pemphigus / 中南大学学报(医学版)

Objective:To determine clinical curative effects of ozone therapy for pemphigus vulgaris.Methods:Ozone hydrotherapy was used as an aid treatment for 32 patients with pemphigus vulgaris.The hydropathic compression of potassium permanganate solution for 34 patients with pemphigus vulgaris served as a control.The main treatment for both groups were glucocorticoids and immune inhibitors.The lesions of patients,bacterial infection,usage of antibiotics,patient's satisfaction,and clinical curative effect were evaluated in the 2 groups.Results:There was no significant difference in the curative effect and the average length of staying at hospital between the 2 groups (P＞0.05).But rate for the usage of antibiotics was significantly reduced in the group of ozone hydrotherapy (P=0.039).The patients were more satisfied in using ozone hydrotherapy than the potassium permanganate solution after 7-day therapy (P＞0.05).Conclusion:Ozone hydrotherapy is a safe and effective aid method for pemphigus vulgaris.It can reduce the usage of antibiotics.

Tratamento de pênfigo vulgar com imunoglobulina humana como adjuvante ao corticoide oral: um relato de caso / Pemphigus vulgaris treatment with human immunoglobulin as adjuvant to oral corticoid: a case report

Introdução: o pênfigo vulgar é uma doença de caráter autoimune, que leva à formação de bolhas locais ou generalizadas causadas pelo ataque de autoanticorpos às estruturas da epiderme. A terapêutica Recebido em: 25/09/2018 com imunoglobulina humana como adjuvante é uma excelente opção para os casos em que há resistência ao tratamento habitual, além de poder diminuir o tempo de tratamento com imunossupressores. Objetivo: descrever um relato de caso sobre um paciente portador de pênfigo vulgar submetido ao tratamento com imunoglobulina humana como adjuvante ao corticoide oral. Relato do caso: paciente 49 anos, foi internado apresentando lesões erosivas em mucosa oral e conjuntival, com piora sistêmica após início de tratamento com antibióticos e anti-inflamatório. Inicialmente realizou-se o tratamento convencional com corticoterapia, porém sem resultados satisfatórios. Devido ao agravamento da clínica, e ao estabelecimento do diagnóstico de pênfigo vulgar, foi incluída no tratamento a imunoglobulina humana como adjuvante, o que culminou em uma melhora progressiva do paciente. Conclusão: apesar de o tratamento do pênfigo vulgar ter os corticoides como primeira opção, é importante conhecer tratamentos adjuvantes e/ou alternativos, como as imunoglobulinas humanas, para auxiliar no tratamento dos pacientes que não respondem ao corticoide.

Introduction: Pemphigus Vulgaris is an autoimmune disease that leads to the formation of local or generalized blisters as a result of autoantibodies against epidermal structures. Therapy with human immunoglobulin as an adjuvant is an excellent option for cases where there is resistance to usual treatment, in addition to being able to reduce the time of treatment with immunosuppressant. Thus, it is an alternative treatment for patients with severe infections or immunological deficiencies. Aim: to describe a case report about a carrier patient of pemphigus vulgaris treated with human immunoglobulin as adjuvant to oral corticosteroids. Case report: patient with 49 years old, was hospitalized in the city of Belo Horizonte (MG) presenting erosive lesions in the oral and conjunctival mucosa, with systemic worsening after starting treatment with antibiotics and anti-inflammatory. Initially, conventional steroid therapy was performed, but with no satisfactory results. Due to worsening symptoms and the diagnosis of Pemphigus Vulgaris, human immunoglobulin was included in the treatment as an adjuvant, which resulted in a progressive improvement of the patient. Conclusion: although treatment of Pemphigus Vulgaris has steroids as the first option, it is vital that the physician knows adjuvant and/or alternative therapies, such as human immunoglobulins, to assist in the treatment of patients who do not respond to steroids.

Abordagem sistêmica do pênfigo vulgar com acometimento oral / Systemic approach of the vulgar penfigure with oral accomplishment

O termo "pênfigo" remete a um grupo de doenças autoimunes raras, caracterizadas pela formação de bolhas, que afetam o epitélio escamoso estratificado da pele, mucosa ou ambos. Cinco tipos principais de pênfigo foram descritos: vulgar (PV), vegetante, eritematoso, foliáceo e paraneoplásico. O PV é a variante mais comum e frequentemente acomete a mucosa oral. Este artigo relata um caso de Pênfigo Vulgar, com acometimento da mucosa oral e com 10 anos de evolução. Paciente de gênero masculino, 70 anos, procurou o serviço, queixando-se de úlceras na mucosa que causavam ardência e não cicatrizavam. Foi realizada uma biópsia incisional da lesão e, após exame histopatológico, estabelecido o diagnóstico de PV, sendo instituído um regime terapêutico com 60 mg de prednisona por via oral, até a remissão dos sintomas. O PV é uma doença sistêmica de caráter imunológico, de grande importância para a odontologia, tendo em vista que geralmente as manifestações orais antecedem as sistêmicas. Essa doença não tem cura, mas pode ser controlada, como no referido caso. Embora o diagnóstico nesse caso não tenha sido precoce, o prognóstico foi favorável... (AU)

The term "pemphigus" refers to a group of rare autoimmune diseases, characterized by the formation of blisters that affect the squamous epithelium stratified of the skin, oral mucosa or both. Five main types of pemphigus were described: pemphigus vulgaris (PV), vegetative, erythematous, foliaceous and paraneoplastic pemphigus. PV is a more common variant and often affects an oral mucosa. This article reports a case of Pemphigus vulgaris, with involvement of the oral mucosa and 10 years of evolution. A male patient, 70 years old, sought the service complaining of ulcers in the mucosa that caused burning and did not heal. An incisional biopsy of the lesion was performed and after histopathological examination, the diagnosis of PV was established, a therapeutic regimen with oral prednisone 60 mg was instituted util remission of symptoms. PV is a systemic disease of immunological character that has great importance for dentistry, since oral manifestations usually precede the systemic ones. This disease has no cure, can be controlled, as in this case, although the diagnosis in this case was not early, the prognosis was favorable... (AU)

Pénfigo vulgar: dificultad en el diagnóstico de un tipo de dermatosis vulvar poco frecuente. Reporte de un caso / Vulgar pemphigus: Difficulty in diagnosis of a infrequent vulvar dermatoses. A case report

Resumen ANTECEDENTES: las alteraciones cutáneas de la vulva suponen un motivo frecuente de consulta a ginecólogos y dermatólogos. Los síntomas suelen ser imprecisos, con prurito y ardor, por lo que las pacientes tardan en acudir a consultar al médico. OBJETIVO: exponer un caso poco frecuente de pénfigo vulgar vulvar; además, revisar la incidencia, manifestaciones clínicas, diagnóstico y estrategias de tratamiento. CASO CLÍNICO: paciente de 86 años de edad que acudió a consulta por la aparición de lesiones vulvares ulceradas y ardorosas de dos meses de evolución. Se obtuvo una biopsia para el estudio histológico, cuyo resultado fue acantólisis y formación de una vesícula intraepidérmica suprabasal, sin evidencia de disqueratosis o necrosis. Se prescribieron corticoesteroides por vía tópica y oral durante un mes. Después de ese lapso se realizó un estudio de control, esta vez de una lesión más reciente, que evidenció infiltrado inflamatorio linfoplasmocitario con aislados eosinófilos, sin permeación del epitelio. La inmunofluorescencia directa reportó depósitos intercelulares de IgG en todo el espesor de la epidermis y de C3 en los estratos suprabasales, con lo que se confirmó el diagnóstico de pénfigo vulgar. CONCLUSIONES: para establecer el diagnóstico de las dermatosis vulvares poco frecuentes es importante efectuar una correcta correlación clínico-patológica, pues la mayor parte de estas enfermedades se manifiestan casi de forma idéntica.

Abstract BACKGROUND: The skin diseases of the vulva are a frequent reason for consultation with both gynecologists and dermatologists. The clinical symptoms are usually vague as pruritus or stinging and patients usually consult later. OBJECTIVE: To document a case of vulgaris vulvar pemphigus, and review the incidence, clinical presentation, diagnostic strategies and treatment. CLINCAL CASE: An 86-year-old patient who came to medical service for ulcerated and burning vulvar lesions of two months of progression. A biopsy was obtained for the histological study, which resulted in acantholysis and suprabasal intraepidermal vesicle, without evidence of dyskeratosis or necrosis. We prescribe topical and oral corticosteroids during a month. Posteriorly, a control study was performed of the most recent lesion that evidenced lymphoplasmacytic inflammatory infiltrate with eosinophilic isolates, without epithelial permeation. Direct immunofluorescence test reported intercellular deposits, IgG throughout the thickness of the epidermis, and C3 in the suprabasal stratum, thus confirming the diagnosis of pemphigus vulgaris. CONCLUSIONS: For correct diagnosis it is essential the clinic-pathological correlation, because many of these diseases manifest themselves almost identically.

Clinical Significance of the Levels of IgG Antibodies Against HSV,CMV and EBV in Patients' Serum with Pemphigus Vulgaris / 现代检验医学杂志

Objective To regard the implication of viruses particularly herpes in pemphigus vulgaris,and assess and compare the level of immunoglobulin G (IgG) antibodies against herpes simplex virus types 1 and 2 (HSV1 and HSV2),cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in patients with pemphigus vulgarisand healthy people.Methods In this study,23 patients with pemphigus vulgaris and 26 healthy individuals comprised the experimental and control groups,respectively.Serum samples were taken from both groups;the levels of IgG antibodies against HSV1,HSV2,CMV and EBV were measured using ELISA.Results Immunoglobulin G titer was higher for all four viruses in the patient group in comparison to the control group.This difference was significant for anti-EBV,anti-CMV and anti-HSV2 (t=2.16,P＜0.05;t =4.76,P＜ 0.01;t=3.75,P＜0.01),respectively,but not significant for anti-HSV1 (t=0.52,P＞0.05).Conclusion Viruses including EBV,CMV,and HSV2 probably play a role in the pathogenesis of pemphigus in addition to the effects of genetics,toxins and other predisposing factors.In this study,no statistically significant relationship was observed between HSV1 and pemphigus vulgaris.More studies must be done in this regard.

Blistering mucocutaneous disease of oral cavity Pemphigus vulgaris 8 year study in Nalgonda population

Background: Autoimmune disorders are conditions in which autoantibodies are directed against a single organ or tissue resulting in localized tissue damage. Pemphigus includes a group of autoimmune blistering diseases of skin and mucous membranes characterized by intra dermal blisters and immunologically by finding of circulating immunoglobulin G antibody directed against the cell surface of keratinocytes. Objectives: To analyze age distribution of Pemphigus vulgaris, prevalence among males and females, predominant oral site and clinical presentation. Materials and methods: A retrospective study of 31 cases of Pemphigus vulgaris obtained over a period of 8 years from January 2008 to September 2015 in the Department of Oral Pathology, Kamineni Institute of Dental Sciences was designed. Clinical details of age, sex, intraoral distribution and oral presentation were noted. P Pavan, T Madhusudan Rao, Pavan G Kulkarni, SRK Nandan, Shyam Prasad Reddy, M Keerthi. Blistering mucocutaneous disease of oral cavity Pemphigus vulgaris – 8 year study in Nalgonda population. IAIM, 2017; 4(1): 58-63. Page 59 Results: Age distribution of Pemphigus vulgaris was 30 – 70 years with a mean age of 49.12 years. Mean age of presentation in males was 45.5 years and in females 46.76 years. Females are more commonly affected than males with a ratio of 2:1. Most commonly affected sites were buccal mucosa, lips and palate, tongue, floor of mouth and skin. Erosions and encrustations were the most common clinical presentation. Conclusion: Pemphigus vulgaris is a fatal disease if left untreated. The skin and the mucosa are majorly involved and oral mucosa is often affected first. The study elucidates the characterization of Pemphigus vulgaris so that early diagnosis can be made. As oral lesions precede, oral health care professionals can play a major role in early diagnosis and managing oral lesions.