Blisters and erosions affecting the oral cavity, scalp, face, and trunk

From th Sy Fund Conf Corre D N A 43-year-old white man presented with a 7-month history of flaccid blisters and shallow erosions affecting his gingival and buccal mucosae associated with odynophagia. The erosions progressed to involve his scalp, face, and back (Fig 1, A and B). These persisted despite oral antibiotics. His medical and family histories were noncontributory. Histopathologic results of a lesional biopsy specimen are shown in Fig 2. Perilesional direct immunofluorescence revealed intercellular immunoglobulin G deposition. Indirect serum immunofluorescence on monkey esophagus and desmoglein 3 transfected cells using biochip technology are shown in Fig 3. Enzyme-linked immunosorbent assay of desmoglein 1 and 3 indices were 77 and 160, respectively.