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Diagnosis and Treatment Challenges of an Atypical Case of Pemphigus vulgaris During the COVID-19 Pandemic

Pemphigus defines a group of rare autoimmune blistering diseases that affect the skin and mucous membranes, with pemphigus vulgaris being the most common form that has increased morbidity and mortality in the absence of an early diagnosis and treatment. We report the case of a 24-year-old male with...

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Autores principales: Banciu, Mădălina Laura, Dobrica, Codruta, Malciu, Ana Maria, Vâjâitu, Cristina, Voiculescu, Vlad Mihai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8887689/
https://www.ncbi.nlm.nih.gov/pubmed/35251811
http://dx.doi.org/10.7759/cureus.21739
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author Banciu, Mădălina Laura
Dobrica, Codruta
Malciu, Ana Maria
Vâjâitu, Cristina
Voiculescu, Vlad Mihai
author_facet Banciu, Mădălina Laura
Dobrica, Codruta
Malciu, Ana Maria
Vâjâitu, Cristina
Voiculescu, Vlad Mihai
author_sort Banciu, Mădălina Laura
collection PubMed
description Pemphigus defines a group of rare autoimmune blistering diseases that affect the skin and mucous membranes, with pemphigus vulgaris being the most common form that has increased morbidity and mortality in the absence of an early diagnosis and treatment. We report the case of a 24-year-old male with an atypical form of pemphigus vulgaris with cutaneous onset and subsequent involvement of the oral cavity. The management of the patient initially consisted of long-term systemic corticosteroid therapy. Following a mild form of SARS-CoV-2 infection and a flare-up of the disease in this context, which was not controlled with high doses of systemic corticosteroids, targeted therapy with rituximab was initiated but immediately stopped due to the manifestations of urticaria and angioedema. Considering the magnitude of these reactions, dapsone systemic therapy i.e., a steroid-sparing agent with minimal risk of infections, was started and managed to control the underlying disease. The management of this case of pemphigus vulgaris was challenging for both the patient and his physician, as the patient developed COVID-19 which caused disease complications and implied additional costs. This case highlights the importance of an accurate diagnosis given the atypical onset of the disease and the financial limitations with the impossibility of performing all confirmatory diagnostic tests.
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spelling pubmed-88876892022-03-03 Diagnosis and Treatment Challenges of an Atypical Case of Pemphigus vulgaris During the COVID-19 Pandemic Banciu, Mădălina Laura Dobrica, Codruta Malciu, Ana Maria Vâjâitu, Cristina Voiculescu, Vlad Mihai Cureus Dermatology Pemphigus defines a group of rare autoimmune blistering diseases that affect the skin and mucous membranes, with pemphigus vulgaris being the most common form that has increased morbidity and mortality in the absence of an early diagnosis and treatment. We report the case of a 24-year-old male with an atypical form of pemphigus vulgaris with cutaneous onset and subsequent involvement of the oral cavity. The management of the patient initially consisted of long-term systemic corticosteroid therapy. Following a mild form of SARS-CoV-2 infection and a flare-up of the disease in this context, which was not controlled with high doses of systemic corticosteroids, targeted therapy with rituximab was initiated but immediately stopped due to the manifestations of urticaria and angioedema. Considering the magnitude of these reactions, dapsone systemic therapy i.e., a steroid-sparing agent with minimal risk of infections, was started and managed to control the underlying disease. The management of this case of pemphigus vulgaris was challenging for both the patient and his physician, as the patient developed COVID-19 which caused disease complications and implied additional costs. This case highlights the importance of an accurate diagnosis given the atypical onset of the disease and the financial limitations with the impossibility of performing all confirmatory diagnostic tests. Cureus 2022-01-30 /pmc/articles/PMC8887689/ /pubmed/35251811 http://dx.doi.org/10.7759/cureus.21739 Text en Copyright © 2022, Banciu et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Dermatology
Banciu, Mădălina Laura
Dobrica, Codruta
Malciu, Ana Maria
Vâjâitu, Cristina
Voiculescu, Vlad Mihai
Diagnosis and Treatment Challenges of an Atypical Case of Pemphigus vulgaris During the COVID-19 Pandemic
title Diagnosis and Treatment Challenges of an Atypical Case of Pemphigus vulgaris During the COVID-19 Pandemic
title_full Diagnosis and Treatment Challenges of an Atypical Case of Pemphigus vulgaris During the COVID-19 Pandemic
title_fullStr Diagnosis and Treatment Challenges of an Atypical Case of Pemphigus vulgaris During the COVID-19 Pandemic
title_full_unstemmed Diagnosis and Treatment Challenges of an Atypical Case of Pemphigus vulgaris During the COVID-19 Pandemic
title_short Diagnosis and Treatment Challenges of an Atypical Case of Pemphigus vulgaris During the COVID-19 Pandemic
title_sort diagnosis and treatment challenges of an atypical case of pemphigus vulgaris during the covid-19 pandemic
topic Dermatology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8887689/
https://www.ncbi.nlm.nih.gov/pubmed/35251811
http://dx.doi.org/10.7759/cureus.21739
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