Herpes Simplex Virus-1 in Oral Pemphigus Vulgaris: A Causal Versus Casual Relationship (Case Report).

Pemphigus vulgaris (PV) is a group of autoimmune bullous diseases that results in multiple chronic mucocutaneous bullae, erosions, and/or ulcers presenting orally first. Several previous studies reported that viral infections, especially herpes simplex virus (HSV), may trigger activation of pemphigus. The relationship between PV and viral infection can be classified into 3 groups which are casual, such as viral infection due to a complication of immunosuppressive therapy, causal, HSV is a trigger before the pemphigus is present, and studies that were examined for HSV infection in PV patients but could not find any evidence. A 37-year-old male had a 4-week history of oral ulceration. Aphthous stomatitis was initially diagnosed, and was treated with chlorhexidine gluconate. Intraoral examination revealed multiple painful erosion with sloughing on the buccal mucosa, labial mucosa and dorsum of the tongue. Anti-HSV-1 IgG was reactive, while ANA test was not. Histopathology examination revealed suprabasal acantholysis. The patient was diagnosed with oral PV concurrent HSV. We used acyclovir, systemic and topical corticosteroids, chlorhexidine gluconate and multivitamin, as well aspharmacological therapy. Some lesion healed without any further clinical sequel within 6 months. The patient is still under observation without any sign of relapse. In this case, HSV was a trigger before the oral PV presented. It is important to know the relationship between oral PV and HSV in order to provide appropriate therapy to the patient and whether or not to use antiviral in oral PV therapy. [ABSTRACT FROM AUTHOR]