Desafio no diagnóstico de doenças vesículo-bolhosas: relato de caso

Abstract

Pemphigus vulgaris (PV) is a rare autoimmune disease manifested by vesicular-bullous lesions involving the mucosa and skin. PV frequently affects women and adults, usually in the 4th to 5th decade of life. It presents clinically on the oral mucosa as painful erosions and ulcerations, in which desquamative gingivitis could be present. The etiology of the disease is still unknown, but it may be associated with genetic factors. Because of its nonspecific clinical features, PV can be easily confused with other vesiculobullous diseases. Therefore, diagnosis is challenging and can be made by a combination of clinical features, histopathology and indirect and direct immunofluorescence (IFD) examination. Although IFD is considered the reference test in the diagnosis of PV, if performed during immunosuppressive treatment or with an incorrect biopsy technique, the result may be false negative. Here we present a case report of a 58-year-old female patient who complained of inflamed gingiva for three years. She reported corticosteroid use, but without resolution. Clinically, it was possible to observe morphological aspects suggestive of desquamative gingivitis. Incisional biopsy and IFD were performed with nonspecific and negative results respectively. The team associated the result with the use of corticosteroids by the patient and opted for symptom control until a new exam could be performed. After three months, it was possible to observe a 90% improvement in painful symptoms and a 30% improvement in the clinical condition of desquamative gingivitis.