Although esophageal lesion of pemphigus vulgalis is rare, its incidence has been increasing with the spread of endoscopes. A 61-year-old man was admitted to our hospital because of idiopatic necrotic head of femur, pyrexia, stomatitis, exanthema and ascites when we followed up esophageal varices and alcoholic cirrhosis. The patient could not ingest because of oral pain. By a biopsy specimen of the erosive skin the patient was diagnosed as pemphigus vulgalis and received local treatment with steroid. It was hard to treat esophageal varices with endoscopy because of detachment of almost entire esophageal mucosa with fresh blood. Therefore, it is important in the follow-up of patients with pemphigus vulgalis to take esophageal lesion into consideration. Furthermore, we suggest that careful attension to endoscopic examination in selected cases of pemphigus vulgalis may reveal a higher incidence of this entity.
