Pathology · patient case question
Which pathology could be confused with (interact with) pemphigus in the differential?
Patient case: Pemphigus vulgaris — confirming the diagnosis
Scenario: A case in which the diagnosis of PEMPHIGUS VULGARIS is given.
Show answer and explanation
Correct answer: C. Mucous membrane pemphigoid
- A. A non-autoimmune ulcerative stomatitis would not reproduce the desquamative gingivitis with positive Nikolsky sign.
- B. Geographic tongue (benign migratory glossitis) presents as migrating erythematous patches with white serpiginous borders on the tongue dorsum only.
- C. Correct. MUCOUS MEMBRANE PEMPHIGOID is the principal differential. Both are autoimmune vesiculobullous diseases producing desquamative gingivitis with a positive Nikolsky sign, and they are separated by the LEVEL OF THE SPLIT on histology (intraepithelial in pemphigus, subepithelial in pemphigoid) and by the immunofluorescence pattern (intercellular fishnet versus linear basement membrane band).
- D. Nicotinic stomatitis is a white, fissured palate with red-dotted inflamed minor salivary gland openings, caused by heat from smoking.
Note: Erosive lichen planus belongs in this differential too — the classic desquamative gingivitis triad is pemphigus vulgaris, mucous membrane pemphigoid and erosive lichen planus.