Case presentation
A 48-year-old female known and previously treated case of pemphigus
vulgaris, presented with a two month history with a pruritic scaly
plaques scattered on scalp, trunk and extremities.
She was complaining from mucocutaneous pemphigus vulgaris from 16 years
before the current presentation. She had received multiple courses of
corticosteroid pulse therapy followed by maintenance treatment with oral
prednisolone. In august 2021, the patient was admitted due to pemphigus
recurrence and treated with a course of Rituximab (two infusions of 1 gr
2 weeks apart) in addition to 30 mg of oral prednisolone. One month
later, she had complete resolution for her skin lesions. Later
prednisolone was tapered gradually.
Her physical examination showed a sharply demarcated, scaly and
erythematous plaques distributed over the scalp, retro auricular skin,
abdomen, presacral area and extensor surface of the upper and lower
extremities. Examination of nails, mucosa, and joints were normal. Skin
biopsy revealed psoriasiform acanthosis, munds of parakeratosis and
suprapapillary plate thinning. Papillary dermis showed vascular
tortuosity and perivascular lymphocytic infiltration compatible with the
diagnosis of psoriasis. Laboratory lab test including complete blood
count, lipid profile, liver function tests, urea, creatinine, ESR and
CRP were normal. Treatment for psoriasis included methotrexate 7.5
mg/week and topical clobetasol. Oral prednisolone was tapered over six
months to 2.5 mg/day. During six months’ of follow up, the psoriatic
plaques had partially improved (PASI score =3.2), erythema and
induration had significantly decreased, and no other sites were
involved. Currently, she is still on methotrexate (10 mg /week) and
low-dose systemic corticosteroid therapy (prednisolone 2.5 mg daily).