case_images: PMC11765791_01
case_images: Dermatological examination: (A)-Erythematous and erosive eruptions partially covered with scab, yellowish crust disseminated on the scalp and face. (B)-Blisters and erosions covered with scabs on the trunk (C)-Erosions of the lip mucosa, whitening of the oral mucosa.
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case_images: However, the patient developed new skin lesions, with a different clinical picture, in July 2021 (Figure 1).
case_images: Patient's antibody follow-up.
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case_images: Pemphigus/pemphigoid antibodies were determined, obtaining the positive result of anti-desmoglein 1 (anti-DSG1) antibodies 1:40 (consistent with pemphigus erythematosus), anti-desmoglein 3 (anti-DSG3) antibodies 1:20 (BIOCHIP, Euroimmun, Germany), and antibodies on monkey esophagus substrate 1:20 (IIF, Euroimmun, Germany) (Table 1, Figure 2). Despite the improvement in the clinical picture in December 2021, there was a described increase in anti-DSG-3 titer from 1:40 to 1:80 (Table 1, Figure 2). In October 2022, a follow-up DES-1 and DES-3 antibody test was performed again, obtaining a negative result (Table 1, Figure 2).
case_images: Clinical examination: (A)-Scarring lesions with follicular hyperkeratosis, erythematous lesions, and erosions covered with scab. (B)-Post-inflammatory discoloration on the skin of the trunk.
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case_images: Then, due to the presence of erosions and new erythematous lesions on the scalp (Figure 3), topical treatment was intensified, whereas AZA (100 mg per day) and prednisone (5 mg per day) were maintained at the previous doses, achieving temporary improvement.
case_images: Direct immunofluorescence examination: (A)-Direct immunofluorescence is seen with intraepidermal intercellular deposition of granular IgG deposits in the intercellular space of the epidermis. (B)-Direct immunofluorescence is seen with Granular deposition of C3 along the dermo-epidermal junction.
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case_images: DIF and lupus band test (LBT) were taken. DIF showed granular deposits of IgG (+) in the intercellular spaces of the epidermis and granular C3 (+) deposits along the dermo-epidermal junction; the LBT was negative (Table 1, Figure 4).