Q: 52 year old male is transferred from neurology floor to ICU for intubation and emergent plasmapheresis due to exacerbation of myasthenia gravis. On exam, you found following skin findings. With given history, your diagnosis and concern?

Answer:  Pemphigus Vulgaris

Pemphigus Vulgaris is an autoimmune disorder found to be associated with myasthenia gravis and thymoma. It requires high dose corticosteroids treatment, otherwise can be fatal. First described 90 years ago1  but is still a valid association and should be investigated and treated aggressively.


References:

1. Senear-Usher, -F.E. and Usher, B. An unusual type of pemphigus combining features of lupusery the matosus. Arch. Derm: Syph., 1926; 13 761.

2. Winkler DT, Strnad P, Meier ML, Roten S, Went P, Lyrer P, Steck AJ: Myasthenia gravis, paraneoplastic pemphigus and thymoma. A rare triad. J Neurol. 2007, 254 (11): 1601-1603.

3. Meyer S, Kroiss M, Landthaler M, Vogt T: Thymoma, myasthenia gravis, eruptions of pemphigus vulgaris and a favourable course of relapsing melanoma: an immunological puzzle. Br J Dermatol. 2006, 155 (3): 638-640.