Refractory pemphigus foliaceus associated with herpesvirus infection: case report

Abstract

Pemphigus foliaceus (PF) is an autoimmune disease characterized by blistering of the skin. Infections caused by members of the herpesviridae family have been suggested as a possible triggering factor for pemphigus vulgaris (PV), but not for PF. The present study aimed to investigate the presence of Human herpesvirus (types 1, 2, 3) in corticosteroid refractory skin lesions from a patient with PF, by a Polymerase chain reaction (PCR) assay. The sample collected from cutaneous blisters has tested positive for herpes simplex virus type 1 (HSV1) after sequence analysis of the amplified viral genomic segment. The study concluded that when PF patients present corticosteroid or immunosuppressants refractory lesions, herpetic infection should be considered.

A difficult case of pemphigus

“…e possible mechanisms include interruption of T-cell tolerance, up-regulation of pro-inflammatory factors in those genetically predisposed, structural damage to keratinocytes resulting in exposure of endogenous antigens, and epitope spreading. [3][4][5] e morphology of PE and HSV infection closely resemble each other and often pose a diagnostic and therapeutic challenge as seen in our case. e prudent use of steroids is therefore to be kept in mind during management of such cases.…”