Pemphigus Vulgaris: Diagnosis with Oral Lesions

Abstract

A 50-year-old patient reported to the dental college with the complaint of a blister and pain in the lower right back region since 2 months. The patient noticed slight bleeding and a blister associated with the lower right second molar on the gingiva 1 year back. He had visited a dentist where periodontal treatment, scaling and root planing were done. Initially, the bleeding subsided and the blister reduced in size but recurred after 6 to 7 months.Intraoral examination revealed localized erosions involving marginal and attached gingiva of the mandibular right first and second molar. Nikolsky's sign was positive, and the epithelium could be easily peeled away ( Fig. 1). Skin lesions were not present. Differential diagnosis of mucous membrane pemphigoid, erosive lichen planus, and PV was arrived at. A gingival biopsy was performed from the perilesional site of the involved gingiva and sent for histopathological examination.Histopathological examination showed acantholysis in the suprabasal region with a "suprabasillar split" (Fig. 2). Intraepithelial vesicle showed Tzanck cells. Connective tissue stroma was loose collagenous with dense inflammatory cells, confirming PV. Patient was asked to undergo Dsg 1 and Dsg 3 tests.Anti-Dsg 1 antibodies were 31.2 U/mL. Anti-Dsg 3 antibodies were 117.4 U/mL. ABSTRACTPemphigus vulgaris (PV) consists of a group of autoimmune blistering diseases of the skin and mucous membrane. The blisters occur in the epithelium where the patient's immunoglobulin G (IgG) autoantibodies are produced in response to triggering factors that target two structured proteins of desmosomes identified as desmogleins (Dsg) 1 and 3. It is essential that dentists should know these pathologies in order to be able to diagnose them at an early stage of the disease and to direct patients for adequate treatment. This article presents a case report along with its treatment plan.