A Case of Pemphigus Vulgaris in a Patient with Human Immunodeficiency Virus

Abstract

Pemphigus vulgaris is the most common variant of autoimmune chronic blistering skin diseases. Its appearance in patients infected with acquired immunodeficiency virus (HIV) is rare. A 40-year-old woman is reported, who presented skin lesions in 90% of the body surface, characterized by blisters of 3 to 4 cm that, when broken, left denuded areas, excoriations and pruritic meliceric crusts. A skin biopsy was performed that showed a characteristic pattern of pemphigus vulgaris. Elisa for HIV positive. She evolved with septic shock and died 72 hours later. Understanding the relationship between HIV and autoimmune blistering disorders can help guide the therapeutic and prognostic management of these patients. Proposed mechanisms include molecular mimicry, polyclonal B-cell stimulation, and highly active antiretroviral therapy possibly associated with immune restoration. Clinically, these patients may present limited mucosal symptoms or develop multiple erosions that may spread, merge, and progress to exfoliative erythroderma. Glucocorticoids serve as the first line of management; however, they can have important adverse effects such as infectious complications that pose a therapeutic challenge for the doctor and could influence mortality.