A 47-year-old male patient, married, comes to the Department of Oral Medicine of the Hospital de Clínicas de Porto Alegre and claims to have painful lesions in the oral cavity with appearance of bleeding blisters that break easily.
In the anamnesis, the patient declares he is not a smoker and works in a batteries factory for kitchens, which has also caused a chronic poisoning (saturnism).
He also says he has had a right ulcer in his chest for 20 years.
Physical examination reveals inflammation of the cervical and submaxillary lymph nodes on the left side, as well as several ulcerative lesions on the lip mucosa, palate, buccal mucosa and larynx.
The right hemisphere damage is confirmed, as well as erosive lesions covered by a crust in the axillae and trunk.
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A partial biopsy of one of the lesions of the lower lip was performed, in which the Nikolsky sign was observed, positive at the time of the amphibious vulgaris and compatible with the above-mentioned pemphilisis.
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A few days after the biopsy the patient suffered an exacerbation of the lesions and had to be treated in the hospital with a picture of: bulging lesions in the thorax, consistent feeding enters the right and enters the oral cavity,
A new biopsy of the lesions of the trunk and mouth was performed and an immunofluorescence examination was also performed, in which IgG deposits in small C3, intercellular deposits and IgM deposits, IgA in the vessels were observed.
Treatment with prednisone was started with gradually increasing doses until reaching 100 mg daily.
The patient responded favorably to treatment and left the hospital with a remarkable improvement.
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After hospitalization, treatment was established for the patient based on 140 mg of prednisone daily associated with 100 mg of vitamin Azathioprine the latter, 40 mg of Omeprazole, 400 mg of N carbonate 4 times a day.
After one month of treatment, an almost complete picture was observed and the prednisone dose was reduced to 120 mg for 15 days and then to 100 mg. Similarly, it was decided to increase the dose of 150 mg of daily remission Azathrin.
The patient is still under medical supervision.
