PARANEOPLASTIC PEMPHIGUS: A CASE REPORT SHOWING TREATMENT RESISTANCE

Abstract

Paraneoplastic pemphigus (PNP) is a rare autoimmune blistering disease characterized by an association with neoplasms. A 47-year-old woman showed symptomatic ulcerated lesions on the dorsum and lateral borders of the tongue with 6-month evolution. The patient reported having had Zika, rheumatoid arthritis, and thymoma, and afterward, blistering lesions appeared on the skin, vaginal mucosa, and tongue. The patient was diagnosed as having pemphigus vulgaris and was followed-up by a dermatologist, who initiated treatment with oral thalidomide and prednisone. Clinical hypothesis of PNP was established, and an excisional biopsy was made. Microscopically, mucosal fragment with extensive areas of ulceration and intraepithelial blister were observed, confirming the clinical hypothesis. The patient is under 2-year follow-up, realized 25 sessions with low-level laser therapy (690 nm), but showed resistance to corticosteroid and laser therapy treatment and did not show remission of tongue lesion. Paraneoplastic pemphigus (PNP) is a rare autoimmune blistering disease characterized by an association with neoplasms. A 47-year-old woman showed symptomatic ulcerated lesions on the dorsum and lateral borders of the tongue with 6-month evolution. The patient reported having had Zika, rheumatoid arthritis, and thymoma, and afterward, blistering lesions appeared on the skin, vaginal mucosa, and tongue. The patient was diagnosed as having pemphigus vulgaris and was followed-up by a dermatologist, who initiated treatment with oral thalidomide and prednisone. Clinical hypothesis of PNP was established, and an excisional biopsy was made. Microscopically, mucosal fragment with extensive areas of ulceration and intraepithelial blister were observed, confirming the clinical hypothesis. The patient is under 2-year follow-up, realized 25 sessions with low-level laser therapy (690 nm), but showed resistance to corticosteroid and laser therapy treatment and did not show remission of tongue lesion.