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Pemphigus Vulgaris: DR Sulamsih Sri Budini

- Mrs. Rukayah, a 23-year old Javanese woman, presented with eroded skin and blisters covering almost her entire body which had begun appearing one month prior. - Physical examination found vesicles, blisters, and erosions on her lips, chest, back, arms, and thighs. Nikolsky's sign was negative. - Differential diagnoses included pemphigus vulgaris and bullous pemphigoid. A biopsy was planned. She was prescribed IV fluids, dexamethasone injections, antibiotics, wet dressings, and ointment.

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Sita Anindita
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77 views

Pemphigus Vulgaris: DR Sulamsih Sri Budini

- Mrs. Rukayah, a 23-year old Javanese woman, presented with eroded skin and blisters covering almost her entire body which had begun appearing one month prior. - Physical examination found vesicles, blisters, and erosions on her lips, chest, back, arms, and thighs. Nikolsky's sign was negative. - Differential diagnoses included pemphigus vulgaris and bullous pemphigoid. A biopsy was planned. She was prescribed IV fluids, dexamethasone injections, antibiotics, wet dressings, and ointment.

Uploaded by

Sita Anindita
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Morning report

PEMPHIGUS VULGARIS
dr Sulamsih Sri Budini
Department Dermato of Venereology Medical Faculty of Airlangga/ dr. Soetomo General Hospital Medical Faculty of Brawijaya/ dr. Saiful Anwar General Hospital 2010

Identity
Name Age Address Sex Religion Race Reg Hospitalized : Mrs. Rukayah : 23 years old : Ds Baran Rt 20/6 Tumpang : Female : Moeslem : Javanese : 1022944 : August 19rd 2010

History
Chief complaint: eroded skin and blisters in almost all of the body Present History:
It was appeared on the chest firstly 1 months ago, spreading to neck, face, lips,back, trunk and her arms Firstly it was small blister that became larger with flaccid wall and fragile but some blisters had tense wall The erosions was excessive and crusting The blisters arised on normal-appearing skin

She felt pain accompanied by the lesions

Past Ilness history


The lesion was appeared 1 months ago firstly Patient had history of lesion on mucous membrane( sariawan) No history of pain swallowing No history of mixturing Fever, minimal a month before hospitalized No history of hipertension and DM No history of the same disease before - No history family with the same disease

History of medication:
3 kinds of pills from nurse For last 1 weeks she was Injected from mantri No history of traditional medicine

Dermatologic Examination August 19rd 2010

L: lips, chest, upper & lower arm E: -erotion, well define cover by black crust that adhere on the base -Vesicle ,blister, 1-3 cm, round shape, tense & flaccid wall, contain clear fluid -Nikolsky sign (-)

L: trunk, back, thigh


R: - vesicle & blisters contains clear fluid with 0,3-1 cm, flaccid wall - Erotions ,well defined & some parts covered by brown& black crust adhere on the base

Physical Examination

General Examination:
VS:CM, BP 130/90 mmHg, PR : 88x/m; RR: 20 x/m; Tax: 37,5C Head / Neck : A -/- , Ict -/-, secret (-/-) Thorax : Cor: wnl; Pulmo :simetris, Rh -/-, Wh -/ Abdomen : flat, soefl, BS (+) H/L not palpable Extremities : edema -/-

Assessment:
Differential Diagnosis:
Pemphigus Vulgaris Bulous Pemphigoid

Diagnosis
Pemphigus Vulgaris

Planning
Dx:
Lab: blood & urine examination, blood sugar, LFT, RFT, Albumin, Electrolite Biopsy

Tx:
IVFD NS 0,9% 20 gtt/m Inj Dexametason 2x1 amp Ciprofloksasin 2x500mg Wet dressing on blisters Sufratul on erosion

Mx:
Vs, lesion

Result of laboratory: August 19rd 2010


Hb :13,5 gr/dl WBC :10.600/m3 Platelet : 316.000/mm3 PCV : 40.6 % SGOT : 23 mU/l SGPT : 32 mU/l Ureum :23,9 mg/dl Creatinin:0,70 mg/dl
Electrolyte: Na : 129 mmol/L K : 4,10 mmol/L Cl : 106 mmol/L Albumin :-

Problem List
Fever Blister and erotion lesions almost of all the body

August,21th ,2010 S O
Pain (+), lesion was dried, new blister (-) General state: CM, VS : BP: 110/80,PR: 88, RR:20 x/m, t 36,9 C Derm.examination : L : lips, trunk, back, arm,thigh E: erotion was dry , well define cover by black crust
thatt adhere on the base, Vesicle ,blister, 1-3 cm was ruptured Nikolsky sign (-)

August,22th , 2010
Pain(+),lesion was dried, new blister (-) General state: CM, VS : BP: 110/80,PR: 84, RR:18 x/m, t 37 C Derm.examination : L : lips,, trunk, back, arm,thigh E:erotion was dry , well define cover by black crust
that adhere on the base, Vesicle ,blister, 1-3 cm was ruptured

A
P

Pemfigus Vulgaris DD. Pemfigoid bulosa


Dx : Tx :IVFD NS 0,9% 20 gtt/m
Inj Dexametason 2x1 amp Ciprofloksasin 2x500mg Wet dressing on blisters Sufratul on erosion

Pemfigus Vulgaris DD. Pemfigoid bulosa


Dx : Tx :IVFD NS 0,9% 20 gtt/m
Inj Dexametason 2x1 amp Ciprofloksasin 2x500mg Wet dressing on blisters Sufratul on erosion

Follow up,August 22 2010

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