Pemphigus vulgaris case report: When common presentations conceal a rare diagnosis

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BSTRACT

A 57-year-old male with a past medical history of newly diagnosed hypertension presented with nonhealing blisters on his back, lips, and buccal mucosa. The patient had been recently started on hydrochlorothiazide before the onset of these lesions. Multiple dermatologic treatment regimens, including bacitracin, topical corticosteroids, cephalexin, trimethoprim-sulfamethoxazole, and mupirocin, failed to produce clinical improvement. A punch biopsy was subsequently performed and confirmed the diagnosis of pemphigus vulgaris (PV). The patient was initiated on oral prednisone 0.5 mg/kg and referred to rheumatology for consideration of rituximab therapy. Treatment with oral prednisone monotherapy has resulted in clinical improvement of the lesions. This case highlights the classic presentation of PV, its distinction from medication-induced hypersensitivity reactions, and the importance of punch biopsies as a reliable, rapid, and minimally invasive diagnostic tool in cases of diagnostic uncertainty, while also emphasizing the associated burden on the patient caused by delays in diagnosis.