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June 1997

Pathological Case of the Month

Author Affiliations

From the Department of Dermatology, Roger Williams Medical Center (Dr Scricca), and the Harvard Community Health Plan of New England (Dr Alper), Providence, RI.

Arch Pediatr Adolesc Med. 1997;151(6):627-628. doi:10.1001/archpedi.1997.02170430093020

AT AGE 10 years, a girl was referred to our dermatology service with a 4-month history of painful, nonhealing, oral erosions; hoarseness; and weight loss. She was unresponsive to treatment. Blisters subsequently developed on her trunk, neck, and face. To this point, her working diagnosis had been aphthous stomatitis and bullous impetigo, for which she had been treated with topical anesthetic and oral antibiotics.

On physical examination, the gingiva revealed beefy, red, superficial erosions (Figure 1). The labia majora had one 0.5-cm superficial erosion. The trunk, neck (Figure 2), and face had a few scattered, flaccid, clear fluid—filled bullae with a slightly erythematous base. A punch biopsy specimen was obtained from the midback (Figure 3).

Diagnosis and Discussion

Pemphigus Vulgaris

While pemphigus vulgaris is the most common form of pemphigus in adults, it is rare in children. A review of the literature reveals only 42 cases since its first description