Pemphigus foliaceus in a patient with skin cancer with metastases to lymph nodes

Introduction. Factors provoking pemphigus foliaceus are drugs, ultraviolet light, radiotherapy or skin damage. Association of pemphigus with malignancy is still controversial.

Objective. To present a patient after resection of skin cancer with metastasis to regional lymph nodes, in whom pemphigus foliaceus had developed.

Case report. A 76-year-old patient after resection of a tumor (carcinoma adnexogenes probabiliter trichoides) was admitted to our department

a few days after the procedure, within the postoperative wound, itchy erythematous-exfoliating skin lesions appeared. Contact dermatitis was diagnosed. The gradual generalization of lesions led to further investigations. Based on the immunological and immunopathological tests the diagnosis of pemphigus foliaceus was confirmed. Azathioprine was introduced, with gradual improvement. On the 10th day of treatment the patient's general condition worsened. Immunosuppressive therapy was discontinued and antibiotics were introduced. Palliative treatment was carried out in a hospice.

Conclusions. Coexistence of malignancy and pemphigus causes therapeutic difficulties and requires a careful approach.