Abstract
A 75-year-old woman was hospitalized with dysphasia, appetite loss and sialorrhea. The chief complaint persisted despite treatment, and upper gastrointestinal endoscopy had not revealed significant findings. Endoscopic examination at our hospital showed erosion and ulceration of the esophagus and the stomach, which we treated as reflux esophagitis and gastritis. However, the symptoms were not alleviated, thus we suspected esophagus pemphigus. Later biopsy specimens of the esophagus revealed suprabasal acantholysis and immunofluorescent studies demonstrated IgG, IgA and C3 deposits. Serum levels of antidesmoglein 3 antibodies were elevated. Her skin and oral cavity were normal, but the above findings indicated a provisional diagnosis of esophagus pemphigus, and oral prednisolone (PSL) 30 mg per day was prescribed. The symptoms disappeared within a few days and the endoscopic findings also improved, so the PSL dosage was gradually reduced. The patient remains on 5.5 mg/day of PSL without disease recurrence. This condition was very difficult to diagnose because the symptoms indicated only esophagitis and gastritis. As far as we know, gastric pemphigus has not been described. However, we postulate that the gastritis was associated with the esophagus pemphigus in this patient because both of these conditions improved in parallel.