A case report : Clinical experience with pemphigus vulgaris initially diagnosed by upper gastrointestinal endoscopy with esophageal Nikolsky phenomenon

Abstract

The patients was 50-year old woman who had feeling of difficulty in swallowing, and she was conveyed first aid to the main complaint by vomiting and vomiting of blood. Esophageal ulcer was detected with first upper gastrointestinal endoscopy (UGE) , and biopsy showed severe dysplasia. Thus, the esophageal carcinoma was doubted initially, and he was introduced to previous medicine for examination and treatment. UGE was performed again in previous medicine, and epithelium detachment of the laryngopharynx epithelium and the hematoma on esophageal mucosa was recognized without contact and easily formed by fiber friction. Because an autoimmune blister symptom was doubted by this Nikolsky phenomenon, he was introduced to department of dermatology of Keio University Hospital. We achieved definitive diagnosis with pemphigus vulgaris (PV) from buccal mucosa biopsy and autoantibody examination. The patients were classified into a mucosal type according to their serum levels of antidesmoglein (Dsg) -1 and Dsg-3 autoantibodies. After dermatology hospitalization, treatment using combination of steroid and immunosuppressant was started, and completely remission was achieved. We report our clinical experience with PV which was initially diagnosed by UGE with esophageal Nikolsly phenomenon.