Ueber Pemphigus vegetans (frambosioides)

Pemphigus vegetans misdiagnosed as condylomata acuminata: A case report

Pemphigus vegetans is a rare variant of pemphigus vulgaris, characterized by vegetating lesions primarily in the flexures. A 41‐year‐old male patient presented with pemphigus vegetans highly mimicking condylomata acuminata, which led to mistreatment. Careful analysis of clinical and laboratory findings enabled us to reach a correct diagnosis and successful treatment.

Pemphigus Vegetans Associated with Intranasal Cocaine Abuse

Background:

Pemphigus vegetans is a rare variant of pemphigus vulgaris, comprising 1 to 2% of all pemphigus cases. Exposures to oral agents such as captopril and penicillamine and, less commonly, physical or chemical factors have been implicated in the development of pemphigus.

Methods:

We report a 42-year-old white male with a 12-month history of hypertrophic, vegetative plaques affecting primarily his external nares and upper lips. The patient had a history of alcoholism and intermittent drug abuse, primarily intranasal cocaine, since his youth. He had been using cocaine heavily three to four times/week for 1 month prior to and 1 month following the onset of the eruption but has since ceased use. His clinical features and histopathologic findings were consistent with a diagnosis of pemphigus vegetans. Treatment with high-dose prednisone (80 mg/d) and mycophenolate mofetil (1.5 g/d) resulted in resolution of the lesions after 18 months.

Results and Conclusions:

To our knowledge, this is the second report proposing an association between intranasal cocaine use and the pemphigus family of disorders. Although the relationship between illicit drug use and the development of pemphigus is unclear, we postulate that intranasal cocaine abuse is operative in our patient's disease. Herein we discuss drug and other external precipitants of pemphigus and review previous case reports of pemphigus associated with illicit drugs.

Renseignements de base:

Le pemphigus végétant est une variante rare du pemphigus vulgaire, comptant pour 1 à 2 % de tous les cas de pemphigus. Un rapprochement a été établi entre l'exposition à des agents oraux tels que le captopril et la pénicillamine et, moins couramment, à des facteurs physiques ou chimiques, dans le développement du pemphigus.

Méthodes:

Nous exposons le cas d'un homme de race blanche âgé de 42 ans ayant des antécédents de plaques végétatives hypertrophiques pendant 12 mois, touchant principalement ses narines externes et ses lèvres supérieures. Le patient avait des antécédents d'alcoolisme et de consommation intermittente de drogues, principalement de la cocaïne prise par voie intranasale, depuis sa jeunesse. Il avait consommé de façon excessive de la cocaïne trois à quatre fois par semaine pendant le mois qui avait précédé et avait suivi l'apparition de l'éruption, mais il a depuis ce temps cessé d'en user. Ses caractéristiques cliniques et les résultats histopathologiques correspondaient à un diagnostic de pemphigus végétant. Le traitement consistant en la prise de fortes doses de prednisone (80 mg/j) et de mycophenolate mofetil (1,5 g/j) a entraîné la résorption des lésions après 18 mois.

Résultats et conclusions:

À notre connaissance, ce rapport est le deuxième qui propose l'existence d'une association entre la consommation de cocaïne par voie intranasale et le groupe de maladies pemphigus. Bien que la relation entre la consommation de drogues illicites et le développement du pemphigus ne soit pas claire, nous postulons que la consommation de cocaïne par voie intranasale a une incidence sur la maladie de notre patient. Nous discutons aux présentes des drogues et d'autres déclencheurs externes du pemphigus et nous examinons les rapports de cas antérieurs de pemphigus associé à la consommation de drogues illicites.

Skin and sensibility: the story of bullae on the human surface

This review presents a concise delineation of the historical roots of nomenclature and first reports of entities recognized today as immunoblistering dermatoses. The scope of the perspective of terminology is the time from Hippocrates BC to past mid-twentieth century AD, and pemphigus is the core of the matter. Researchers in this field may find these important historic facts interesting and useful as a quick reference.

Pemphigus vegetans. Neumann type and Hallopeau type

Two cases of pemphigus vegetans are presented, one of the Neumann type and one of the Hallopeau type. The differences between the two subsets are clinical presentation and course. Patients with the Hallopeau type often have a relatively benign disease, require lower doses of systemic corticosteroids, and usually have a prolonged remission. Patients with the Neumann type have a course similar to pemphigus vulgaris, need higher doses of systemic corticosteroids, and have relapses and remissions. The histologic findings in the vegetating lesions are similar in both types. The immunopathologic features of both types are indistinguishable and similar to pemphigus vulgaris. IgM staining of eosinophilic microabscesses was observed in one case.