Pemphigus vulgaris presenting as an isolated crusted plaque of the cheek

A healthy 45-year-old man presented with a three-month history of an isolated enlarging eroded plaque on the left cheek. Pemphigus vulgaris was diagnosed by biopsy and positive direct immunofluorescence. The patient was lost to follow up, but returned two months later with generalized cutaneous involvement without mucosal involvement. He responded rapidly to oral corticosteroid therapy.