Pemphigus associated with metastatic carcinoid

Recurrent pemphigus vulgaris limited to the surgical area after mastectomy

A 45-year-old Japanese female presented with bullae and erosions on the trunk in December 1987. The histologic findings revealed a suprabasal cleft and acantholytic cells. Immunofluorescence staining showed IgG autoantibodies in the intercellular spaces. With a working diagnosis of pemphigus vulgaris, she was treated successfully with low dosage prednisolone. Adenocarcinoma of the right breast was found in March 1994, and she received a mastectomy followed by breast reconstruction that used a transverse rectus abdominis muscle flap. Six months later, vesicobullous eruptions developed and were limited to the surgical area (right chest and abdomen). The histopathologic and direct immunofluorescence findings were consistent with pemphigus vulgaris. Although these skin lesions improved with high dosages of prednisolone, she died of multiple metastases due to the breast cancer.