Abstract
A 46-year-old male complained of oral and pharyngeal pain and hoarseness. Multiple irregular erosions with white coating were noted in the oral cavity, oropharynx, and larynx. The coating was removed easily, but the removal caused bleeding. There were no skin lesions. Biopsy of the oral mucosa was performed for diagnosis, but the result was inconclusive. About a month later several bullae developed on the upper and lower limbs. A biopsy of the skin of the left forearm showed intraepidermal bullae caused by acantholysis. A fluorescent antibody test (direct method) revealed intercellular IgG depositions. These findings led to a diagnosis of pemphigus vulgaris.
It is difficult to diagnose pemphigus vulgaris by biopsy of only the oral mucosa when lesions are limited to the oral cavity, because the oral mucosa peels easily, and specimens are often damaged. Therefore, cytological examination of the oral lesion and serological examination with a fluorescent antibody technique (indirect method) should be added when pemphigus vulgaris is suspected.
