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Pathology · patient case question

The buccal erythema and sensitivity to spicy foods in this patient indicate:

Patient case: Vesiculobullous Disease

demo: 55-year-old female

chief: “Spicy food burns terribly and my gums peel.”

history: Six-month history of oral ulceration preceding any skin involvement. No fever.

meds: None

findings: Diffuse buccal mucosal erythema with ragged erosions, desquamative gingivitis, and flaccid bullae that rupture readily. Gentle lateral pressure on adjacent normal-appearing mucosa produces a new blister.

  1. Mucosal involvement by the disease process
  2. Simple mechanical trauma from the toothbrush
  3. A superimposed candidal infection
  4. An allergic contact reaction to toothpaste
Show answer and explanation

Correct answer: A. Mucosal involvement by the disease process

  • A. Correct. Pemphigus vulgaris characteristically presents in the mouth first, and the eroded mucosa is exquisitely sensitive to acidic and spicy foods.
  • B. Mechanical trauma would not produce widespread bullae or a positive Nikolsky sign.
  • C. Candidiasis presents with removable white plaques or diffuse atrophic erythema, not flaccid bullae and ragged erosions.
  • D. Contact reactions localize to the areas of contact and resolve on withdrawal of the agent.

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