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.