Therapeutic difficulties in a patient with pemphigus foliaceus

Abstract

A case of 49-year old male, who manifested extensive, varied in size, erythematous skin lesions with shallow erosions, on trunk. A diagnosis of pemphigus foliaceus was stated upon clinical manifestations, direct immunofluorescence examination, indirect immunofluorescence examination and enzyme-linked immunosorbant assay for desmoglein 1 antibodies in serum. The patient was initially treated with prednisone and azathioprine, according to consensus of Polish Dermatological Society. After two weeks of treatment, the patient was hospitalized in surgery ward, due to escalated stomach-ache. In the ward, esophageal mycosis and inflammation of the mucuous membrane of the stomach were observed and considered as treatment’s complications. Due to adverse events observed, second line therapy was administered: cyclophosphamide and methylprednisolone (initially in pulses, than orally). Improvement in clinical manifestations was noted.