Pemphigus vulgaris mimicking nose tumor
Abstract
Introduction: Pemphigus vulgaris (PV) is an autoimmune bullous dermatosis. PV clinical presentation is characterized by painful blisters, and skin and mucous membranes erosions. The first symptoms of PV are localized mainly in mucous, followed by the appearance of skin lesions several weeks later. Pemphigus localized as an isolated skin nasal lesion, without any prior mucosal involvement occurs rarely.
Case report: A 55-year-old patient was admitted to the Dermatology Department with the suspicion of pemphigus disease. The patient underwent the excision of a nasal tumor at the Department of Plastic Surgery a month earlier, but the lesion started to reappear. Initially, the histopathological examination suggested a diagnosis of acantholytic acanthoma, removed completely, but further diagnostics at the Dermatology Department confirmed the presence of PV. The patient was treated initially with a corticosteroid course and one month after rituximab administration was added, achieving good clinical response and tolerance.
Conclusions: The cases of localized pemphigus vulgaris, without mucosal involvement may cause diagnostic difficulties. The differential diagnosis should consider both the results of the ELISA test and direct immunofluorescence (DIF) examination to avoid misdiagnosis.
Keywords: bullous diseasenasal tumorskin tumorplastic surgerydirect immunofluorescenceELISArituximab
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