Pemphigus Foliaceus Complicated by Kaposi Varicelliform Eruption.

A Kaposi varicelliform eruption (KVE) refers to a widespread cutaneous infection with a virus that often causes local vesicular eruptions over a pre-existing skin disease. Pemphigus foliaceus complicated by KVE is rare. We report the case of a 68-year-old Chi-nese woman with pemphigus foliaceus complicated by KVE. A 68-year-old woman was admitted to our hospital with a 14-month history of erythema and bullae distributed over the entire body. Fourteen months prior to evaluation in our hospital she was diagnosed with pemphigus and was prescribed prednisone as primary therapy. One month prior to evaluation in our hospital more severe lesions recurred because of the sudden discontinuation of the prednisone treatment. She denied any systemic diseases. On physical examination, multiple erythematous erosions, crusts, and scales were noted on the face, trunk, and upper limbs (Figure 1, a). No bullae were present and the oral mucosa was not involved. Routine blood and urine testing, liver and kidney function, and blood glucose and lipid levels were normal. A biopsy of tho-racic lesions revealed acantholysis on the upper spi-nous layer (Figure 1, b). Direct immunofluorescence (DIF) demonstrated immunoglobulin G (IgG) and immunoglobulin M (IgM) deposits in the epidermal intercellular space (Figure 1,c). Indirect immunofluo-rescence (IIF) showed circulating antibodies directed against the intercellular substance (titer=1:1280). A diagnosis of pemphigus foliaceus was made. Intravenous methylprednisolone (80 mg qd) combined with intravenous immune globulin 20g qd (0.4 g/kg/d for the first 3 days) was administered. After ten days, the lesions gradually resolved. On the 11 th day, however, the patient reported malaise and complained that the facial lesions had suddenly worsened. On physical examination, a widespread eruption of several closely-grouped, painful blisters and crusts on the erythematous skin of the face and chest typical of a herpetic infection Figure 1. a) Erythema, erosions, crusts on the chest. b) Dermatopathology revealed acantholysis on the upper spinous layer (hematoxylin and eosin ×100), c) Direct immunofluorescence (DIF) demonstrated immunoglobulin G (IgG) and immunoglobulin M (IgM) deposits in the epidermal intercellular space.