Candida smear-an adjunct for diagnosis of acantholytic cells in oral pemphigus vulgaris.

Pemphigus Vulgaris (PV) is an autoimmune intraepidermal blistering disorder of the skin and mucous membranes.1 Oral lesions have been reported as an initial manifestation of the disease in 50% of cases.2 A case of pemphigus vulgaris is hereby described occurring in a 55-year-old man with a chief complaint of 3-month history of chronic oral erosions and burning sensation. He had several superficial erosions on the buccal mucosa and ventral surface of tongue. Lip crusting was also seen without involvement of gingiva and hard palate. Candida smear using methylene blue staining, revealed acantholytic cells with absence of Candida hyphae (Figure-1). The smear was taken from buccal mucosa with the help of cement spatula and evenly spread on a glass slide and fixed using heat. Slide was covered with methylene blue for 7-10 minutes, washed with distilled water, dried and examined under microscope. Other investigations including biopsy and direct immunofluorescence were in favour of pemphigus vulgaris based on three independent sets of criteria–clinical features, histology and immunological tests.3