Skip to main content

Advertisement

Log in

A case of bleeding duodenal ulcer with pemphigus vulgaris during steroid therapy

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

We report a rare case of bleeding duodenal ulceration in the different form of pemphigus vulgaris (PV). A 52-year-old female was diagnosed with acute pharyngitis and administered methylprednisolone. After several days, melena and many blisters were noted on her body. Endoscopy revealed blood oozing from the second part of a duodeneal ulcer around the major duodenal papilla. After initial endoscopic hemostasis, we observed a large regional, shallow duodenal ulcer. The blisters were suspected to represent the Nikolsky’s sign. The histological findings of her skin were characterized by suprabasal acantholysis and mixed inflammatory cell infiltrates, including scattered eosinophils. There were no other significant findings on skin biopsy or by direct immunofluorescence. Enzyme-linked immunosorbent assay showed an elevated titer of anti-desmoglein 3 autoantibodies in her serum, and the patient was finally diagnosed with mucosal-dominant PV. Although we performed multiple biopsies from the esophagus, stomach and duodenum, the samples did not contain significant findings to enable us to distinguish from pemphigus vulgaris. Corticosteroids remain an essential component of PV treatment. When clinicians encounter PV development during steroid therapy, upper gastrointestinal complications should be considered and diagnostic endoscopy conducted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Akman A, Kacaroglu H, Yilmaz E, Alpsoy E. Periodontal status in patients with pemphigus vulgaris. Oral Dis. 2008;14:640–3.

    Article  CAS  PubMed  Google Scholar 

  2. Scully C, Challacombe SJ. Pemphigus vulgaris: update on etiopathogenesis, oral manifestations, and management. Crit Rev Oral Biol Med. 2002;13:397–408.

    Article  PubMed  Google Scholar 

  3. Dagistan S, Goregen M, Miloglu O, Cakur B. Oral pemphigus vulgaris: a case report with review of the literature. J Oral Sci. 2008;50:359–62.

    Article  PubMed  Google Scholar 

  4. Su O, Onsun N, Meric Teker A, Cinkaya A, Yasemin Korkut A, Seremet S, et al. Upper airway tract and upper gastrointestinal tract involvement in patients with pemphigus vulgaris. Eur J Dermatol. 2010;20(6):792–6.

    PubMed  Google Scholar 

  5. Korman NJ. Pemphigus. Dermatol Clin. 1990;8(4):689–700.

    CAS  PubMed  Google Scholar 

  6. Meurer M, Millns JL, Rogers RS, Jordon RE. Oral pemphigus vulgaris. A report of ten cases. Arch Dermatol. 1977;113(11):1520–4.

    Article  CAS  PubMed  Google Scholar 

  7. Amagai M. Autoimmunity against desmosomal cadherins in pemphigus. J Dermatol Sci. 1999;20(2):92–102.

    CAS  PubMed  Google Scholar 

  8. Harman KE, Gratian MJ, Bhogal BS, Challacombe SJ, Black MM. A study of desmoglein 1 autoantibodies in pemphigus vulgaris: racial differences in frequency and the association with a more severe phenotype. Br J Dermatol. 2000;143(2):343–8.

    Article  CAS  PubMed  Google Scholar 

  9. Rao PN, Samarth A, Aurangabadkar SJ, Pratap B, Lakshmi TS. Study of upper gastrointestinal tract involvement in pemphigus by esophago-gastro-duodenoscopy. Indian J Dermatol Venereol Leprol. 2006;72(6):421–4.

    Article  PubMed  Google Scholar 

  10. Eliakim R, Goldin E, Livshin R, Okon E. Esophageal involvement in pemphigus vulgaris. Am J Gastroenterol. 1988;83:155–7.

    CAS  PubMed  Google Scholar 

  11. Gomi H, Akiyama M, Yakabi K, Nakamura T, Matsuo I. Oesophageal involvement in pemphigus vulgaris. Lancet. 1999;354:1794.

    Article  CAS  PubMed  Google Scholar 

  12. Herrod PJ, Kamali D, Pillai SC. Triple-ostomy: management of perforations to the second part of the duodenum in patients unfit for definitive surgery. Ann R Coll Surg Engl. 2011;93(7):e122–4.

    Article  CAS  PubMed  Google Scholar 

  13. Green SB, Gail MH, Byar DP. Steroids and peptic ulcer. N Engl J Med. 1976;294:1291–3.

    Google Scholar 

  14. Messer J, Reitman D, Sacks HS, Smith H Jr, Chalmers TC. Association of adrenocorticosteroid therapy and peptic-ulcer disease. N Engl J Med. 1983;309:21–4.

    Article  CAS  PubMed  Google Scholar 

  15. Conn H, Poynard T. Corticosteroids and peptic ulcer: meta-analysis of adverse events during steroid therapy. J Intern Med. 1994;236:619–32.

    Article  CAS  PubMed  Google Scholar 

  16. Kenneth EL. How I manage H. pylori-negative, NSAID/aspirin-negative peptic ulcers. Am J Gastroenterol. 2009;104:190–2.

    Article  Google Scholar 

  17. Grando SA. Pemphigus autoimmunity: hypotheses and realities. Autoimmunity. 2012;45(1):7–35.

    Article  CAS  PubMed  Google Scholar 

  18. Carson PJ, Hameed A, Ahmed AR. Influence of treatment on the clinical course of pemphigus vulgaris. J Am Acad Dermatol. 1996;34:645–52.

    Article  CAS  PubMed  Google Scholar 

  19. Lever WF, Goldberg HS. Treatment of pemphigus vulgaris with methotrexate. Arch Dermatol. 1969;100(1):70–8.

    Article  CAS  PubMed  Google Scholar 

  20. Krain LS, Landau JW, Newcomer VD. Cyclophosphamide in the treatment of pemphigus vulgaris and bullous pemphigoid. Arch Dermatol. 1972;106(5):657–61.

    Article  CAS  PubMed  Google Scholar 

  21. Galloro G, Mignogna M, de Werra C, Magno L, Diamantis G, Ruoppo E, et al. The role of upper endoscopy in identifying oesophageal involvement in patients with oral pemphigus vulgaris. Dig Liver Dis. 2005;37(3):195–9.

    Article  CAS  PubMed  Google Scholar 

  22. Calka O, Akdeniz N, Tuncer I, Metin A, Cesur RS. Oesophageal involvement during attacks in pemphigus vulgaris patients. Clin Exp Dermatol. 2006;31(4):515–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosures

Conflict of Interest:

The authors declare that they have no conflict of interest.

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed Consent:

Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kazuhito Gotoh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Niho, K., Nakasya, A., Ijichi, A. et al. A case of bleeding duodenal ulcer with pemphigus vulgaris during steroid therapy. Clin J Gastroenterol 7, 223–227 (2014). https://doi.org/10.1007/s12328-014-0476-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-014-0476-4

Keywords

Navigation