From oral erosions to lymphoma: a case of paraneoplastic pemphigus with occult lymphoma

A 67-year-old female with type-2 diabetes mellitus presented with recalcitrant painful oral erosions and violaceous chest lesions, that responded minimally to oral corticosteroids. Due to history of decreased appetite, weight loss and poor therapeutic response, further evaluation was performed, revealing elevated C-Reactive Peptide, Desmoglein-3 antibody, Carbohydrate Antigen 19-9, and intraperitoneal lobulated homogeneously enhancing nodal mass, the latter indicating lymphoma. Histopathology from oral mucosa was suggestive of paraneoplastic pemphigus. The patient was referred to oncology department for further management. This case underscores the importance of thorough evaluation in elderly patients with recalcitrant mucocutaneous lesions with atypical histopathology.