A Case on Pemphigus Vulgaris with Superadded Infection, Hypoalbuminemia and Hyponatremia

Abstract

Pemphigus vulgaris (PV) is a rare autoimmune disease that is characterized by painful blistering and erosion of the skin and mucous membrane. In the case in hand, a female patient of 44 years was presented with complaints of painful vesicles all over the body with erosions, with no history of fever, headache, or cough. The patient had previously been treated for the lesions over the body, considering them to be chicken pox. The patient was admitted to our hospital without any relief. A skin biopsy was done, a specimen was sent for direct immunofluorescence, and the reports were consistent with pemphigus vulgaris. Blood investigation reports revealed the presence of neutrophilic leucocytosis, elevated CRP, hyponatremia, and hypoalbuminemia. The treatment started with IV Dexamethasone (8mg q 8 hours) along with analgesics, IV fluids, and saline soakings. Secondary infections were managed with antibiotics, antibacterial creams, and other supportive medicines. The patient was provided with sodium supplementation and was advised to eat a protein-rich diet. During the hospital stay, the patient developed foul-smelling discharge from vesicles, and antibiotic treatment was escalated, suspecting pseudomonal infections. Antibiotic ear drops were added to the regimen for painful lesions in the ear and mouth. Artificial tears were added for painful eye lesions. The patient was discharged symptomatically better with sterile blood and pus cultures, healthy skin, and a tapered steroid dose. It is important to consider the nutritional requirements of the patient. Due to the painful nature of oral lesions, PV can result in an impaired nutritional status.