A 31 year old female presented with painful oral ulceration, crusted erosive plaques of scalp and
flaccid bullae of torso in 2017. She was diagnosed with pemphigus vulgaris based on characteristic
clinical, histological and immunofluorescence findings and treated with monthly dexamethasone
pulses and mycophenolate mofetil but unable to achieve remission for 3 years. Repeated evaluation
for associated autoimmune disorders and malignancies were negative. While on treatment she
developed recurrent episodes of blistering eruptions with dermatomal distribution.
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