Pemphigus Vegetans Masquerading as Condyloma Lata - A Rare Case Report

Abstract

Pemphigus vegetans is an uncommon variant of pemphigus vulgaris, developing in areas of relative occlusion. A 42-year-old female presented with multiple raised lesions over the genitalia of one-month duration having a classical morphology of condyloma lata, but her RPR, TPHA and ELISA for HIV 1 and 2 were negative. The patient was treated symptomatically and was lost for follow-up. The patient presented subsequently after 2 months with multiple linear vegetative plaques with superficial erosions situated over the inferior part of the external genitalia and perianal region. There were hemorrhagic crusts on the lips.  A final diagnosis of pemphigus vegetans was established considering the clinical morphology, histopathological and immunofluorescence study. The patient also had an excellent response to systemic steroids, which further corroborated the final diagnosis. Thus, pemphigus vegetans closely mimics condyloma lata if it occurs in the genital area. This case is being reported to highlight the diagnostic dilemma between condyloma lata due to its classical appearance and the next clinical presentation which raised the suspicion of pemphigus vegetans.

Pemphigus vegetans is an uncommon variant of pemphigus vulgaris (1 to 2%) characterised by cauliflower-like vegetating plaques in the flexures.^[1] Pemphigus vegetans appears in moist areas of relative occlusion and friction like axilla, groin and inframammary areas. It is classified into a milder form, the Hallopeau type and a severe form the Neumann type. The involvement of oral mucosa in pemphigus vegetans is variable (60 to 80%).^[1] This case is being reported because of its rare presentation in the genitals rather than classical sites of the disease.