Esophagitis Dissecans Superficialis Associated With Mucosal Pemphigus vulgaris: A Rare and Underrecognized Clinical Presentation

Esophagitis dissecans superficialis (EDS) is an uncommon desquamative disorder most frequently associated with chemical, thermal, and medication-related injury or bullous autoimmune diseases such as pemphigus vulgaris (PV). We report a case of mucosal-dominant PV presenting with progressive oral ulceration and symptomatic EDS in the absence of cutaneous involvement. The diagnosis was confirmed by oral mucosal biopsy demonstrating suprabasal acantholysis and positive serum anti-skin immunoglobulin G (IgG) antibodies, despite nondiagnostic direct immunofluorescence. Treatment with systemic corticosteroids resulted in rapid clinical improvement. This case underscores the importance of considering mucosal-dominant PV in patients with persistent oral ulceration and gastrointestinal symptoms that fail to respond to standard initial therapy.