Case 2:
Case History and Examination A 55-year-old male with no significant past medical history presented with a two-month history of difficulty swallowing solid food without any systemic alarming signs. Endoscopy revealed a stenotic gastroesophageal junction, with furrows and a web-like structure observed above it (Figure 2b). Biopsies taken from these areas demonstrated numerous eosinophils, consistent with a diagnosis of eosinophilic esophagitis (EoE). The patient was started on oral steroids at a dosage of 1 mg/kg per day for four weeks, followed by a tapering regimen, which led to significant improvement in his dysphagia. He remained asymptomatic for six months. After this period, the patient sought a dermatology consultation for an acute rash. He presented with flaccid bullae on his chest, back, buttocks, lower legs, and anterior oral mucosa (Figure 2a).
Methods: Differential Diagnosis, Investigations, and TreatmentThe differential diagnosis for the acute rash included PV and other autoimmune blistering diseases. A skin biopsy and direct immunofluorescence (DIF) confirmed the diagnosis of PV, showing suprabasal epidermal acantholysis and intercellular deposits of C3 and IgG in the epidermis. The patient was initially treated with oral prednisone at a dosage of 1 mg/kg per day for four weeks, followed by a tapering regimen. He was then switched to azathioprine at a dosage of 2 mg/kg per day due to relapse after stopping the systemic steroid.