USMLE Forum Archives - USMLE Step 2 CK - 54 years..alcoholic(blisters)
54 years..alcoholic(blisters)
hamzarayes2010 - 10-27-08 16:19
54year old alcoholic lady complaining of painful non-itchy blisters which are easily ruptured, on exam.there were lesions on her mouth She had +ve nickolicks sign.what is the most likely diagnosis?
a.urticaria
b.pemphigus vulgaris
c.bullous pemphigoid
d.pemphgus folecius
hamzarayes2010 - 10-27-08 16:19
54year old alcoholic lady complaining of painful non-itchy blisters which are easily ruptured, on exam.there were lesions on her mouth She had +ve nickolicks sign.what is the most likely diagnosis?
a.urticaria
b.pemphigus vulgaris
c.bullous pemphigoid
d.pemphgus folecius
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#2
Re: 54 years..alcoholic(blisters) mohhaider - 10-28-08 01:39 Yes ,it's pemphigus vulgaris as it's associated with mouth lesions ,and positive Nickolisky sign which present in three medical conditions (pemphigus vulgaris ,SSSS,and toxic epidermal necrolysis )
#3
Re: 54 years..alcoholic(blisters)
hamzarayes2010 - 10-28-08 02:56 Right answer.in situ , & tnx mohhaider 4 da explanation.
My second question regardlng pemphigus vulgaris is what r da other precipitans of this state ?
#4
Re: 54 years..alcoholic(blisters) sackatdoc - 10-28-08 03:06 the importance of the question is to differentiate pemphigus with -phigoid
pemphigus has antibodies to adhesion molecules(cathedrin&desmosomal protein)so intra (in between epidermal cells)epidermal blisters. where as -oid sub epidermal with antibodies against basement membrane.
flaccid in -gus and tense in -oid
gus in middle age and oid in elderly
nickolosky pos. in -gus and neg. in -oid
-gus a/w neoplastic diseases and -oid has no association
-gus can be fatal if untreated but oid has spontaneous remissions and exacerbations
SO remember pemphigus is serious and -oid is not!!!
#5
Re: 54 years..alcoholic(blisters) bingousmle - 10-28-08 03:46 i think lymphoma is the neoplasm in which paraneoplastic pemphigus occurs and myasthenia is also an associated with pemphigus
#6
Re: 54 years..alcoholic(blisters) sackatdoc - 10-28-08 04:05 yes lot of benign and malignant conditions associated with pemphigus, and once it is diagnosed needs appropiate treatment as can be fatal, has serious electrolyte abnormalities
#8
Re: 54 years..alcoholic(blisters) babbu5508 - 06-23-10 04:46 b.pemphigus vulgaris.
The most common form of pemphigus is pemphigus vulgaris . It occurs when antibodies attack Desmoglein 3.
#9
Re: 54 years..alcoholic(blisters) bingousmle - 06-30-10 17:39 this lady suffers from pemphigus vulgaris as the bullae are easily ruptured and nikolskys sign is positive.. alcohol aggravated the lesions
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