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Stressful Life Events as a Trigger for Autoimmune Disease? A Case Report on Mucous Membrane Pemphigoid Robert Devine Melanie Simms Dental Update 2024 48:5, 707-709.
Authors
RobertDevine
BDS (QMUL), MJDF
Dental Core Trainee in Oral and Maxillofacial Surgery, Royal United Hospitals, Bath
This case discusses the acute presentation of a patient with mucous membrane pemphigoid to an emergency dental department. Mucous membrane pemphigoid is a rare condition, but its presentation can be severe and concerning for both the patient and clinician. The case presents the manifestations of florid desquamative gingivitis and extensive mucosal erosions due to burst bullae. We discuss the possible causes of the condition in this patient, likely to be the stress of recent cardiac surgery, as well as exploring the efficacy of diagnostic tools, treatment options and adverse effects of corticosteroid treatment.
CPD/Clinical Relevance: Correct and timely diagnosis of vesiculobullous disorders has notable impacts on patient outcomes and quality of life.
Article
Mucous membrane pemphigoid (MMP) is a rare subepithelial bullous disorder predominantly involving the oral mucosa. Other mucous membranes that may be affected include the upper part of the aerodigestive tract, conjunctiva and genital mucosa. Occasionally the skin may also be involved.1 There is an inflammatory autoimmune response directed against the hemidesmosome adhesion complex, leading to subepithelial clefting and the clinical appearance of desquamative gingivitis, blisters or erosions. This case presents an acute presentation of MMP as florid desquamative gingivitis and extensive mucosal erosions. This article explores the efficacy of diagnostic tools available to identify the condition, discusses the immediate, short- and long-term treatment modalities as well as hypothesizes potential initiating stressor events and response to therapy.
A 64-year-old male presented to the dental emergency department at the University Hospital, Wales, complaining of painful, ‘peeling’ and bleeding gums. He found that brushing his teeth made the gums develop blood-filled blisters, prior to bursting and leaving a painful ulcerated area that did not heal. The patient reported one single episode of a blister on the skin of his nose that had since healed, and reported no other cutaneous, genital or ocular symptoms.
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