A 76-year-old male patient came to the ophthalmology department for pain, tearing and discharge in the left eye (OI) associated with severe red eye of 1 month's evolution. A month earlier, the ENT department had clinically diagnosed a suspected mucous pemphigus vulgaris in the throat and mouth, pending biopsy, for which he was being treated with Prednisone 30 mg a day. His general history included hypercholesterolemia treated with torvastatin.
Ophthalmological examination showed a visual acuity (VA) of 1.2 in the right eye (OD) and 1.0 in the OI. Biomicroscopy (BPA) revealed a large blister in the nasal sector of the bulbar conjunctiva, associated with hyperemia, which progressed to erosion within 24 hours; the rest of the examination was normal in both eyes. It was then decided to perform a conjunctival biopsy in the office under topical anaesthesia in the area of the lesion. Treatment with gentamicin ointment and fluorometholone eye drops every 8 hours was started. Histopathology revealed a suprabasal intraepithelial bulla while direct IF showed deposits of Immunoglobulin G (IgG) in the intercellular spaces of the conjunctival epithelium. Upon establishing the diagnosis of Pemphigus Vulgaris, the dose of Prednisone was raised to 60 mg/day, resulting in remission of ocular symptoms after two months.