TITLE:
When the Mouth Speaks First: Isolated Oral Pemphigus Vulgaris—A Case Report and Literature Review
AUTHORS:
Salma Azizi Alaoui, Wafaa Mahfoud, Kaoutar El Khalifa, Lamia Kissi
KEYWORDS:
Pemphigus Vulgaris, Mouth Mucosa, Stomatitis, Autoimmune Diseases, Corticosteroids, Acantholysis, Immunofluorescence, Tooth Extraction
JOURNAL NAME:
Open Access Library Journal,
Vol.13 No.3,
March
18,
2026
ABSTRACT: Background: Pemphigus vulgaris (PV) is a rare autoimmune blistering disease in which oral lesions often precede cutaneous involvement. Early diagnosis may be delayed because of nonspecific presentations. Case Presentation: A 28-year-old woman presented with a one-year history of painful oral bullae and erosions without skin lesions. Clinical examination revealed multifocal erosions and a positive Nikolsky’s sign. Histopathology demonstrated suprabasal clefting, acantholysis, and a “tombstone” basal layer, confirming PV. Systemic prednisone (60 mg/day) resulted in significant improvement within 10 days. Persistent inflammation related to impacted mandibular third molars was addressed surgically. By day 40, oral lesions had fully resolved; however, new-onset dysphagia raised concern for pharyngeal or esophageal involvement, necessitating referral to internal medicine. Conclusion: This case underscores the importance of early biopsy, recognition of local inflammatory triggers, and coordinated multidisciplinary care in isolated oral PV to prevent disease progression.