To the Editor.
—We read with interest the report by Fullerton et al1 of a patient with paraneoplastic pemphigus after autologous bone marrow transplantation. Of note, their patient had no evidence of diffuse large-cell lymphoma at the time of autopsy. His lymphoma seems to have been in remission for the 6 months prior to the development of his blistering cutaneous eruption. In the last sentence of the article, the authors write "our patient clearly demonstrates that an associated neoplasm need not be active or detectable" in paraneoplastic pemphigus.This brings up the question of whether paraneoplastic pemphigus is truly paraneoplastic. The Greek prefix para- means beside, and the course of paraneoplastic phenomena has traditionally been expected to approximately parallel a malignant process in order for a causal relationship to be demonstrated.2 Fullerton et al elegantly demonstrate that their patient had the same disorder described by Anhalt et al.
Helm TM, Camisa C, Valenzuela R. Perplexing Parlance of Paraneoplastic Pemphigus. JAMA. 1992;268(5):602. doi:10.1001/jama.1992.03490050050015