DR.NITHIYARAJ AP, Dept Of Emergency Medicine SMVMCH
DR.KIRUBA SHANKAR SR, Dept Of Emergency Medicine SMVMCH
INTRODUCTION:
Pemphigus vulgaris is an autoimmune bullous dermatoses disorder with varying incidence from 0.5to 3.2 cases per 100,000 population per year. It generally characterised by mucosal erosions, vesicles and bulla over scalp, face, axial and seborrheic area occasionally lesions can be localised ,ruptured blisters on skin may be painful areas of oozing and denuded skin and limit persons daily activity. Complication due to infection can be serious and damaging nature. If left untreated disease will progress steadily with an average time of death of 14 months.
CASE DESCRIPTION:
A 45years old female was referred from a private hospital to our ER with complaints of fluid filled blisters which further developed to multiple raw areas associated with pus discharge over the scalp, face, neck, chest and axilla for 30days. Initially patient self-diagnosed as chicken pox and bought over the counter tab.acyclovir 400mg tds and consumed for a period of 10days. Furthermore it progressed with odynophagia leading to poor oral intake and cachexia. Initially on arrival her vitals were GCS 15/15 (E4 V5 M6) blood pressure 80/60mmhg, PR- 123/min, RR-23 breaths/min, temp-101*f. Systemic examinations were normal. Cutaneous examination showed multiple large eroded and crusted lesions present in craniocaudal distribution involving chest, abdomen and back, both oral and conjunctival mucosa, had extensive ulcerative lesions over an erythematous base with crusting and serosanguineous fluid. Nikolsky sign was positive. In ER we secured a central line in the femoral region and all relevant investigations were sent and patient was managed with intravenous fluids ,antipyretics, adequate pain management done with inj.morphine 3mg. Patient was started on inj.meropenem 1g (after test dose) and inj.dexamethasone 8mg as patient was in sepsis with neutropenia with secondary thrombocytosis. Patient was catheterised and the urine was high coloured and Ryles tube was placed for enteral feeding. Dressing was done with saline and fusidin ointment.
Expert opinion was obtained from Dermatology department for further evaluation and management of the lesions. Patient was treated as by a multidisciplinary team and was improved and discharged.
CONCLUSION
It’s not wrong to take care of one’s self but self-medicating and diagnosing based on what the internet says has turned to be fatal in this case. we often don’t see much Dermatological cases reported in our daily ER with the above mention features. One must not limit their diagnosis to common presentation and rather have uncommon diagnosis in mind.