Pemphigus Vulgaris in a Black Patient: Early Recognition of Disease Saves Lives

There is a well-known shortage of racial diversity in medical textbooks and literature contributing to race-based health care inequalities1. We present the case of a black puertorrican 58-year-old female who developed a painful non-pruritic blistering ulcer in the inner oral mucosa with associated erythema six months prior to the evaluation. She was misdiagnosed on multiple occasions leading to a rapid progression of the disease, and subsequently, her death. Lack of images in medical textbooks and scarce literature describing initial presentation per-skin-tone of Pemphigus Vulgaris (PV) in patients with dark skin color led to misdiagnosis, delay in treatment, and thus, this catastrophic outcome. This case report describes the appearance of PV in patients with dark skin tone and serves as an educational resource by providing images of a rare skin disease in people with dark skin. The purpose of this case report is to fill major gaps in medical literature, highlight the importance of timely recognizing PV in patients with dark skin, and to create awareness among physicians.