Case presentation
A 48-year-old female known and previously treated case of pemphigus vulgaris, presented with a two month history with a pruritic scaly plaques scattered on scalp, trunk and extremities.
She was complaining from mucocutaneous pemphigus vulgaris from 16 years before the current presentation. She had received multiple courses of corticosteroid pulse therapy followed by maintenance treatment with oral prednisolone. In august 2021, the patient was admitted due to pemphigus recurrence and treated with a course of Rituximab (two infusions of 1 gr 2 weeks apart) in addition to 30 mg of oral prednisolone. One month later, she had complete resolution for her skin lesions. Later prednisolone was tapered gradually.
Her physical examination showed a sharply demarcated, scaly and erythematous plaques distributed over the scalp, retro auricular skin, abdomen, presacral area and extensor surface of the upper and lower extremities. Examination of nails, mucosa, and joints were normal. Skin biopsy revealed psoriasiform acanthosis, munds of parakeratosis and suprapapillary plate thinning. Papillary dermis showed vascular tortuosity and perivascular lymphocytic infiltration compatible with the diagnosis of psoriasis. Laboratory lab test including complete blood count, lipid profile, liver function tests, urea, creatinine, ESR and CRP were normal. Treatment for psoriasis included methotrexate 7.5 mg/week and topical clobetasol. Oral prednisolone was tapered over six months to 2.5 mg/day. During six months’ of follow up, the psoriatic plaques had partially improved (PASI score =3.2), erythema and induration had significantly decreased, and no other sites were involved. Currently, she is still on methotrexate (10 mg /week) and low-dose systemic corticosteroid therapy (prednisolone 2.5 mg daily).