Histopathological Features of Recurrent Oral Ulceration Diagnosed as Oral Pemphigus Vulgaris: A Case Report

Background: Pemphigus is a rare group of life-threatening muco-cutaneous autoimmune blistering diseases. Frequently, oral lesions precede the cutaneous ones. Sometimes oral clinical features could be misdiagnosed as aphthous ulcer especially when cutaneous lesion could not be found. Histopathology examination is essential to diagnose any vessicobullous diseases. Case report: A case of 44-year-old man with chief complaint recurrent oral ulceration since two years ago, working diagnosed as suspect tuberculosis cutis orificalis was reported. Histopathological examination showed suprabasilar blisters contained of acantholytic cells. Basillary cells remained attached to the basement membrane and lamina propria, arranged like thombstones appearance. Lymphocytes and neutrophills were the main inflammatory cells in dermis. Discussion: Clinically, it may be difficult to differentiate recurrence aphthous-like ulcer as oral pemphigus, especially when oral lesion was the main clinical feature. To make diagnose of pemphigus, histopathological examination is necessary and must be done. In some case when both direct and indirect immunofluorescence could not be performed, immunohistochemistry is one of alternative to determine the autoantibodies that involve in disease. Unfortunately this examination is not available in our department and several studies still on going in purpose to replace immunofluorescence with immunohistochemistry.