Possible pemphigus vulgaris outbreak: case series

Background

Pemphigus vulgaris is an autoimmune disease that causes blisters on skin and/or the mucous membrane. It is the most common suprabasilar splitting disease in the oral cavity, with the oral cavity often showing the first signs of this condition. Though still a serious disease, pemphigus vulgaris can usually be treated with modern medical advances. In clinical practice, pemphigus vulgaris is most often seen in middle-aged female. We describe three cases of pemphigus vulgaris in male patients.

Case description

25-year-old, 30-year-old, and 50-year-old healthy male patients presented with multifocal painful erosions and ulcerations in the oral cavity. The second and third patients also had blisters and ulcers on their skin. The lesions appeared a few weeks following the injection of the COVID-19 vaccine. Biopsies were performed from either the oral lesions or skin lesions. All specimens displayed suprabasilar epithelial separation with acantholysis. Further investigation with direct immunofluorescence testing, and anti-desmoglein ELISA were conducted. These tests confirmed the diagnosis of pemphigus vulgaris. The treatment included topical steroids, systemic steroids, and Rituximab (anti-CD20 monoclonal antibody, IV).

Conclusion

There may be a rise in immune-mediated diseases in previously healthy patients of atypical age and gender demographics. If pemphigus vulgaris is diagnosed, further clinical history to include asking about COVID-19 infection/vaccination may be of interest to further evaluate any possible connection.