2010 Volume 120 Issue 14 Pages 3109-3114
In 1998, a 31-year-old man visited us with a 7 year history of recalcitrant psoriasis. He was treated with topical corticosteroid, vitamin D3, oral etretinate, methotrexate, and PUVA. In 2004, without any prodromal symptoms, high fever and painful pustules developed within psoriatic plaques with erosions of oral mucosa. A diagnosis of Kaposiʼs varicelliform eruption was made and followed by an intravascular administration of acyclovir. The fever subsided in a few days. However, bullae and erosions developed at the margin of the psoriatic plaques. A skin biopsy of a bulla revealed acantholytic blister, and a direct immunofluorescence test showed intercellular depositions of IgG and C3 in the epidermis. A diagnosis of pemphigus vulgaris was made, and the patient was treated with oral prednisolone 60 mg/day and methylprednisolone pulse therapy (1 g/day, three days). The coincidence of pemphigus vulgaris with psoriasis vulgaris is a rare phenomenon, and the development of psoriasis vulgaris precedes that of pemphigus vulgaris in most cases. According to some previous case reports, a herpes simplex virus infection can provide a clue to a diagnosis of pemphigus.