Non-drug-induced pemphigus foliaceus in a patient with rheumatoid arthritis.

VOLUME 97, MARCH 2016 E1 WWW.CUTIS.COM To the Editor: The term pemphigus describes a group of autoimmune blistering diseases that are histologically characterized by intraepidermal blisters caused by acantholysis. There are several types of pemphigus foliaceus, such as classic and endemic pemphigus foliaceus, pemphigus erythematosus, pemphigus herpetiformis, and drug-induced pemphigus foliaceus.1 Drug-induced pemphigus foliaceus in patients treated with penicillamine for rheumatoid arthritis (RA) is well documented in the literature.2 An association between pemphigus foliaceus and RA without penicillamine therapy is rare. We present a case of a patient with a history of RA who developed this bullous disease. A 67-year-old woman with a 15-year history of seropositive RA presented with widespread skin lesions of 4 weeks’ duration. Confluent scaly crusted erosions on an erythematous base were present on the back (Figure 1), chest, and abdomen. There was no alteration of the mucous membranes. Medical treatment consisted of methotrexate (10 mg weekly), folic acid (5 mg twice weekly), prednisolone (5 mg daily), and ketoprofen (50 mg daily). Routine blood analysis was unremarkable, except for a positive rheumatoid factor. Histologic examination showed a subcorneal Non–Drug-Induced Pemphigus Foliaceus in a Patient With Rheumatoid Arthritis