Abstract
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.