Pemphigus Foliaceus with Secondary AMPC-Producing Acinetobacter Species: A Rare Skin Disease

Abstract Pemphigus foliaceus (PF) is a rare autoimmune blistering disorder characterized by autoantibodies targeting desmoglein 1 (Dsg1), leading to superficial skin erosions and crusted lesions. This case report describes a 47-year-old woman who presented with pruritic lesions on her scalp, trunk, and limbs. The diagnosis was confirmed through histological evaluation and direct immunofluorescence, which revealed intercellular immunoglobulin G staining. Complicating her condition was a secondary infection caused by Acinetobacter species, an amoxicillin-clavulanate (a beta-lactamase inhibitor)-producing bacterium, requiring targeted antibiotic therapy. A comprehensive treatment regimen, including systemic corticosteroids, rituximab, azathioprine, and supportive care, resulted in substantial clinical improvement. This case underscores the importance of early diagnosis, individualized immunosuppressive therapy, and vigilant infection management in achieving optimal outcomes for PF patients. It also highlights the challenges of secondary infections in immunocompromised states, emphasizing the need for a multidisciplinary approach to care.