Difficulties in diagnosing pemphigus vulgaris

Vulgar pemphigus is a rare, potentially fatal autoimmune disease characterized by formation of intraepidermal blisters and extensive erosions on the skin and mucous membranes. Despite significant advances in investigation of the pathogenesis and treatment of pemphigus vulgaris, the diagnosis of this disease remains challenging. The difficulty in early diagnosis of bullous dermatoses, particularly pemphigus vulgaris, is due to the non-specific nature of the initial clinical manifestations. The typical primary lesion of the oral mucosa (erosions, aphtha-like elements) often leads to misinterpretation of the symptoms and delayed diagnosis. The problem is exacerbated by the lack of awareness among primary care physicians (dentists, otolaryngologists, and general practitioners) about this condition. The paper focuses on the difficulties in diagnosing pemphigus vulgaris. A case narrative described a patient whose disease began with nonspecific rash on the oral mucosa which made it difficult to make an accurate diagnosis for a long time. Based on the results of a cytological examination of smears from the surface of new erosions, the oncologist diagnosed “N2NxMx cancer of the lower lip” and performed radiation therapy, which aggravated the disease. The paper discusses possible causes of diagnostic errors.