INTRODUCTION
Pemphigus vulgaris (PV) refers to a group of autoimmune, blistering diseases that results in lesions affecting predominantly the mucosa and skin. Autoantibodies (anti-Dsg1 and anti-Dsg3) target desmogleins (Dsg1 and Dsg3), expressed respectively in superficial epidermis and mucosa, and cause loss of cell adhesion.5 Glucocorticoids are the first-line treatment for pemphigus vulgaris followed by immunosuppressants such as mycophenolate mofetil, methotrexate, or more recently a B-cell-depleting therapy with rituximab, is also well-established. Here, we describe the case of a patient who refused conventional forms of treatment and responded well to a nonconventional treatment (bromocriptine mesylate) in combination with a low dose of prednisone.
CASE REPORT
A 45-year-old female presented in March 2022 with a two-year history of being diagnosed with PV. The patient reported a flare including umbilical involvement, crusted lesions on the scalp and erosions that caused itching and burning sensation on face, trunk, and abdomen (Figure 1A). There was no mucosal involvement noted at the time of flare. The scalp ulcerations caused significant discomfort, affecting patient's ability to sleep. Patient complained of severe itching with subsequent burning over the lesions. Her blood test revealed highly elevated Dsg-1 (131 U/mL) and relatively elevated Dsg-3 (6 U/mL) (Table 1). In November 2020, abdominal punch biopsy was carried out and report revealed intraepidermal acantholytic blister with a supra-basal cleavage plane consistent with the diagnosis of
