A therapeutic dilemma of oral pemphigus vulgaris in pregnancy: A case report

Introduction: The present case report aimed to provide information on the oral manifestations and management of pemphigus vulgaris (PV) during pregnancy. Case report: A 25-year-old woman diagnosed with PV was under dermatological treatment since 2011. In January 2018, she was referred to the oral medicine (OM) clinic of Dr. Cipto Mangunkusumo General Hospital due to oral ulcers. Her clinical examination revealed desquamation and crust on the lips, erosions, desquamation and sloughing of the gingiva, erosions on the palate and poor oral hygiene. She was treated with topical dexamethasone and chlorhexidine gluconate 0.2% mouth rinse as well as systemic methylprednisolone, azathioprine, CaCO3 and ranitidine. The patient was pregnant after her fifth visit to the OM clinic and her PV was clinically worsening with eruption of new lesions on oral mucosa and skin. Although uncommon, oral manifestations of PV can occur during pregnancy which complicates its management and creates a therapeutic dilemma due to the need of higher dose of medication when the PV flares up, but on the other hand, the drugs used are known to have teratogenic effect. Conclusion: Interdisciplinary comprehensive treatment is highly recommended to ensure maternal and fetal safety in such cases. Accordingly, the prescription of methylprednisolone was restricted, while azathioprine and CaCO₃ were discontinued. The patient's response to therapy was continuously monitored at each visit which showed continuous improvement and the fetus was growing well.