LONG-TERM CLINICAL COURSE OF PEMPHIGUS VULGARIS WITH PREDOMINANTLY RECURRENT ORAL INVOLVEMENT: A LONGITUDINAL CASE REPORT AT DR BATRA’S

Abstract

Background: Pemphigus vulgaris (PV) is a chronic autoimmune blistering disorder characterized by intraepidermal acantholysis and mucosal and/or cutaneous lesions. Oral involvement may be persistent and can significantly interfere with eating and quality of life.

Case Presentation: A 64-year-old female with a history of pemphigus vulgaris diagnosed in 2008 presented with recurrent painful oral ulcerative lesions, predominantly involving the buccal mucosa and sublingual region. The initial disease history documented oral lesions beginning in 2007, followed by blistering lesions over the breast and back. Lesions subsequently became predominantly mucosal, with recurrent painful ulcers, burning, difficulty eating solid food, gingival inflammation and occasional bleeding. The patient had also developed diabetes mellitus in the context of prolonged corticosteroid exposure. A biopsy performed in 2019 was reported as consistent with pemphigus, demonstrating a suprabasal blister with acantholytic cells and inflammatory/granulation tissue. The patient received conventional treatment at different stages, including corticosteroids, antibiotics, antifungal treatment and topical oral preparations, while individualized homeopathic treatment was also continued.

Outcome: Longitudinal follow-up from 2014 to 2026 demonstrated periods of improvement and exacerbation. Oral lesions gradually became more manageable, with several follow-ups documenting fewer or milder aphthous/pemphigus-like lesions, reduced pain and improved ability to eat. However, intermittent recurrence persisted, particularly during periods associated with infections, constipation, medication changes and other clinical stresses. By August 2026, the record described the patient as clinically stable apart from intermittent oral fungal symptoms and other comorbid complaints.

Conclusion: This case illustrates the prolonged and fluctuating clinical course of pemphigus vulgaris with predominant oral involvement over more than a decade. The longitudinal record highlights the importance of sustained follow-up, monitoring of corticosteroid-related comorbidities, management of oral complications and individualized supportive care. The observations from a single case cannot establish treatment efficacy or causality.