Print version ISSN 0365-0596
An. Bras. Dermatol. vol.87 no.2 Rio de Janeiro Mar./Apr. 2012
Pyodermatitis-pyostomatitis vegetans: a differential diagnosis of pemphigus vegetans*
Piodermatite-pioestomatite vegetante: um diagnóstico diferencial do pênfigo vegetante
Kleyton de Carvalho MesquitaI; Ana Carolina de Souza Machado IgrejaII
IGraduate student (M.Sc.) in Health Sciences - University of Brasilia (UnB) - Dermatologist of the State Department of Health of the Federal District (SES-DF)- Brasilia (Federal District), Brazil
IIPhysician of the Dermatology Residency Program, University Hospital of Brasilia/University of Brasilia (UnB) - Brasilia (Federal District), Brazil
In the November/December 2011 issue of the Anais Brasileiros de Dermatologia (Brazilian Annals of Dermatology), Adriano et al.1 reported a case of druginduced pemphigus vegetans (PV). We congratulate the authors on the thorough documentation of the patient as well as on the detailed discussion of the topic. However, we would like to emphasize the importance of considering pyodermatitispyostomatitis vegetans (PD-PSV) in the differential diagnosis of PV, given that their clinical presentation and histological findings are similar.2 PD-PSV is a rare inflammatory disease characterized by pustular and vegetating plaques that affect the skin and mucous membranes.3 Both PD-PSV and PV present intra and/or subepithelial abscesses with numerous eosinophils and neutrophils on histological examination. The distinction can only be made by immunofluorescence (IF),4 since direct and indirect IF are normally negative for PD-PSV.2 However, PD-PSV may show weakly positive direct IF, representing a response to epithelial damage. In spite of the similar immunosuppressant regimen, diagnostic differentiation between PD-PSV and PV is essential. PD-PSV has been described as a highly specific marker of Inflammatory Bowel Disease (IBD), with ulcerative colitis being the most common disorder.4,5 Patients with PD-PSV, therefore, must be monitored for early detection of IBD onset and present better dermatologic prognosis.
1. Adriano AR, Gomes Neto A, Hamester GR, Nunes DH, Di Giunta G. Pemphigus vegetans induced by use of enalapril. An Bras Dermatol. 2011;86:1197-200. [ Links ]
2. Mehravaran M, Kemény L, Husz S, Korom I, Kiss M, Dobozy A. Pyodermatitispyostomatitis vegetans. Br J Dermatol. 1997;137:266-9. [ Links ]
3. Matias FAT, Rosa DJF, Carvalho MTF, Castañon MCMN. Pyodermatitis-pyostomatitis vegetans: case report and review of medical literarture. An Bras Dermatol. 2011;86(4 Supl 1):S137-40. [ Links ]
4. Nigen S, Poulin Y, Rochette L, Lévesque M, Gagne E. Pyodermatitis-pyostomatitis vegetans: two cases and a review of the literature. J Cutan Med Surg. 2003;7:250-5. [ Links ]
5. Leibovitch I, Ooi C, Huilgol S, Reid C, James C, Selva D. Pyodermatitis-pyostomatitis vegetans of the eyelids. Ophthalmology. 2005;112:1809-13. [ Links ]
Kleyton de Carvalho Mesquita
SGAN 605, Avenida L2 Norte
CEP: 70840-901 - Brasilia - DF - Brazil
Received on 12.02.2012.
Approved by the Advisory Board and accepted for publication on 14.02.2012.
Conflict of interest: None
Financial funding: None
* Work conducted at the University Hospital of Brasilia - University of Brasilia (UnB) - Brasilia (Federal District), Brazil