The patient underwent numerous tests as outlined above. It was thought likely that her streptococcal bacteremia was due to a secondary infection of her severe ulcerative oropharyngeal disease, and she was treated with penicillin. She was sent home on steroids and six months of INH, with subsequent notification of her county health department. The clinical manifestation is of thin-walled intraepithelial bullae on cutaneous and mucosal surfaces. Approximately sixty percent of PV cases present initially as oral mucosal erosions that may occur up to one year prior to the development of cutaneous signs.
Oral lesions develop in almost all patients and can occur on any of the oral mucous membranes.
Other vesicobullous disorders with oral presentations include erythema multiforme and benign mucous membrane pemphigoid, also known as cicatricial pemphigoid. Other illnesses that present in similar fashion include herpetic gingivostomatitis, recurrent aphthous ulcers, erosive oral lichens planus, linear IgA dermatitis, and epidermolysis bullosa aquisita. Circulating antibody titers can be determined, and titers usually correlate well with disease activity or extent. Steroids may also be used in conjunction with azathioprine, cyclophosphamide, plasmapheresis, or gold. Unlike PV, oral lesions are rare, cutaneous blisters are apparent, the IgG in this disease is directed toward the basement membrane zone, and there is a significant polymorphonuclear neutrophil reaction.