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Pemphigus Vulgaris Heralded by Acute Paronychia:A Case Report and Review of the Literature
Hua-en Lee, Wen-Rou Wong, Mei-ching Lee , Hong-Shang Hong
Dermatol Sinica 22 : 41-45, 2004

Acute paronychia, presenting as abscess formation involving the paronychium of the nails, is thought to be an uncommon feature of pemphigus vulgaris(PV). We report a patient with PV who developed acute paronychia of multiple fingernails and toenails, that precede to the exacerbation of other mucocutaneous lesions. A biopsy specimen of the paronychium of the finger revealed suprabasal acantholysis with pustule formation. Direct immunofluorescence study of the same lesion showed intercellular deposition of immunoglobulin(Ig) G and C3. Systemic corticosteroids and azathioprine were effective in treating both the nail disease and mucocutaneous lesions. We concluded that in patients with PV, acute paronychia could be a manifestation of the disease per se, rather than an infectious process.

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