PMC8294838_01
Lesions at the first appointment. A - Ulcerative lesions in the ventral surface of the tongue; B - Lesions with an ulcerative surface in lower labial mucosa (biopsy site); C - Ulcers in glans and foreskin; D - Ulcer in the mucosa of the lower eyelid.
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Oral lesions involved the upper and lower lip mucosa, the tongue's ventral surface, hard palate, soft palate, oral commissures, lower alveolar mucosa, oral mucosa, and upper and lower gums (Figure 1).
Photomicrographs of the biopsy specimen. A - Intraepithelial blister with a single layer of basal cells recovering the conjunctive tissue and lymphoplasmacytic inflammatory infiltrate with eosinophils (H&E, 5X); B - High magnification of image A (H&E, 20X); C - Ulcered area with grouped acantholytic cells (*) with degenerative alterations (H&E, 40X); D - View of the inferior area of epithelial blister and suprabasal slit showing tiny area with rare basal cells still attached to the conjunctive tissue (H&E, 40X); E - Positive direct immunofluorescence showing IgG3 in the intercellular space of cells of the remaining epithelium basal layer on the conjunctiva.
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The histopathological report showed PV and DIF confirmed the diagnosis with positive detection of intercellular IgG3 (Figure 2).
Lesions on the last follow-up. A - Ulcerative lesions in the ventral surface of the tongue; B - Ulcers in the transition between alveolar mucosa and lower labial mucosa; C - Remission of lesions in glans and foreskin; D - Absence of lesion in the lower eyelid.
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However, ulcers of the oral cavity remain in the lower labial mucosa and ventral surface of the tongue (Figure 3).