P2324 - A Case of Pemphigus Vulgaris Found on Endoscopy in a Septic Patient Presenting with Odynophagia

Tulika Saggar, MD¹, Atul Sinha, MD¹, Sandra Gomez, MD¹, James R. Pellegrini, MD², Prachi Anand, MD¹, Nausheer Khan, MD¹, Paul Mustacchia, MD, MBA^1
1Nassau University Medical Center, East Meadow, NY; ²Nassau University Medical Center, Great River, NY

Introduction: Pemphigus vulgaris (PV) is an autoimmune disease that presents with blisters on the skin and mucous membranes. Steroids are the treatment of choice once the diagnosis is made, however, getting to a diagnosis can be difficult without having blisters that are visible. We present a case of a patient presenting with sepsis and odynophagia who was diagnosed with PV after endoscopic evaluation discovered the lesions.

Case Description/Methods: A 58-year-old female with a history of upper respiratory infection 2 months ago presented with a one month history of odynophagia and dysphagia to solids and liquids, which resulted in 20lb weight loss due to decreased PO intake. Symptoms did not improve with amoxicillin and lidocaine mouthwash given by urgent care providers. CT of the soft tissue neck revealed sinusitis and bilateral cervical lymphadenopathy. Patient was admitted to the hospital for sepsis for suspected upper respiratory infection. Gastroenterology was consulted and upper endoscopy was performed which showed multiple oropharyngeal ulcers. Biopsies revealed pemphigus vulgaris on pathology. Patient began a course of oral steroids with significant improvement in symptoms and is now doing well on rituximab.

Discussion: Pemphigus vulgaris is a rare autoimmune disease that can be very distressing for patients. The blistering oral lesions causing pain and odynophagia may not always be apparent, leading to delayed diagnosis. A high index of suspicion is necessary to make the diagnosis and begin treatment in this very active disease. Failure to treat patients in a timely manner can lead to sepsis and even death. Our patient was admitted with sepsis thought to be due to another source, however, rapid diagnosis and treatment lead to a good outcome.



Disclosures:


Tulika Saggar, MD¹, Atul Sinha, MD¹, Sandra Gomez, MD¹, James R. Pellegrini, MD², Prachi Anand, MD¹, Nausheer Khan, MD¹, Paul Mustacchia, MD, MBA¹. P2324 - A Case of Pemphigus Vulgaris Found on Endoscopy in a Septic Patient Presenting with Odynophagia, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.