SHM Converge Scientific Abstract ePoster Gallery-Rapidly Progressive Pemphigus Vegetans With Polymicrobial Superinfection in a Young Man

Pdf Summary

This case describes a 27-year-old man with eczema and polysubstance use disorder who developed a rapidly progressive, pruritic rash over two months. The lesions began on the scalp and spread to the peri-auricular region, neck, chest, abdomen, and right axilla. He had only temporary improvement with oral antibiotics, then worsened after stopping them. On presentation, he was tachycardic, met sepsis criteria, and had leukocytosis, anemia, hypoalbuminemia, hyponatremia, and hypocalcemia. Toxicology was positive for cocaine.<br /><br />A punch biopsy showed epidermal acanthosis, suprabasal acantholysis, and eosinophilic microabscesses, confirming pemphigus vegetans, a rare variant of pemphigus vulgaris that can mimic infectious or eczematous dermatitis. Cultures revealed polymicrobial superinfection with methicillin-susceptible Staphylococcus aureus and Pseudomonas aeruginosa, which likely contributed to the severe inflammatory appearance and systemic findings.<br /><br />He was initially treated with IV vancomycin and cefepime; vancomycin was stopped after two days, and cefepime was continued for seven days followed by oral cephalexin and ciprofloxacin. Systemic prednisone and high-potency topical corticosteroids were started, along with nutritional supplementation for mild protein-calorie malnutrition. Because pemphigus vegetans can be associated with inflammatory bowel disease, GI follow-up was arranged, and addiction-medicine referral was provided.<br /><br />The patient improved markedly after corticosteroid therapy, with resolution of tachycardia and clinical stabilization. He was discharged on a prednisone taper, topical steroids, oral antibiotics, and close multidisciplinary follow-up. The case highlights the importance of early biopsy, targeted antimicrobial therapy, and timely immunosuppression in rapidly progressive skin disease that can resemble severe infection.

Asset Subtitle

Mohammad M. Azam

Meta Tag

Author List Mohammad M. Azam, Ranjeet M. Goswami

Category Clinical Vignettes

Concept Pemphigus vegetans

Concept Suprabasal acantholysis

Concept Systemic Corticosteroid

Concept Vegetating plaque

Concept Eosinophilic microabscess

Distinguished Non-Finalist

Presenter Organization Northwell Health

Presenting Author Mohammad M. Azam

Track Adult

Keywords

pemphigus vegetans

pemphigus vulgaris

rapidly progressive rash

eczema

polysubstance use disorder

superinfection

Staphylococcus aureus

Pseudomonas aeruginosa

corticosteroid therapy

skin biopsy

Pemphigus vegetans

Suprabasal acantholysis

Systemic Corticosteroid

Vegetating plaque

Eosinophilic microabscess