Pemphigus erythematosus is an autoimmune chronic bullous disease involving the skin and mucous membranes. It is a variant of Pemphigus foliaceus with features of both pemphigus and lupus erythematosus, clinically presenting as flaccid bullae with crusted erosions in a seborrheic distribution, at times concurrent with more lupus-like discoid lesions. Several case reports have documented that Pemphigus erythematosus may have atypical presentation, mimicking contact dermatitis, small plaque parapsoriasis, or even seborrheic keratosis. This is a case of a 27-year old Filipino Female who presented with erythematous, non-blanching macules, patches, and plaques after intake of anti-TB medications. ANA immunofluorescence, anti-dsDNA, and anti-histone IgG were high while complement C3 was low. Histopathology was consistent with leukocytoclastic vasculitis. However, there was also noted subtle acantholysis with subcorneal blister. Direct immunofluorescence (DIF), on the other hand, showed granular intercellular deposits of IgG, granular intercellular deposits of lgA, and strong granular vascular deposits of fibrinogen. Due to financial constraints, ELISA Desmoglein 1 and 3 were done one month after starting the patient on systemic corticosteroids, giving a negative result. Still, coupling the histopathology and DIF result, the patient was diagnosed as a case of Pemphigus erythematosus with connective tissue-associated vasculitis. The patient was given systemic and topical corticosteroids with noted 90% improvement of erythematous patches and plaques after two weeks. This case demonstrated that pemphigus erythematosus may present with atypical lesions such as vasculitis. Careful examination and correlation of clinical features, laboratories, and histopathology is fundamental to arrive at a correct diagnosis.

Human ; Female ; Adult: 25-44 Yrs Old ; Vasculitis