RECURRENT PEMPHIGUS-VULGARIS LIMITED TO THE SURGICAL AREA AFTER MASTECTOMY

A 45-year-old Japanese female presented with bullae and erosions on th e trunk in December 1987. The histologic findings revealed a suprabasa l cleft and acantholytic cells. Immunofluorescence staining showed IgG autoantibodies in the intercellular spaces. With a working diagnosis of pemphigus vulgaris, she was treated successfully with low dosage pr ednisolone. Adenocarcinoma of the right breast was found in March 1994 , and she received a mastectomy followed by breast reconstruction that used a transverse rectus abdominis muscle flap. Six months later, ves icobullous eruptions developed and were limited to the surgical area ( right chest and abdomen). The histopathologic and direct immunofluores cence findings were consistent with pemphigus vulgaris. Although these skin lesions improved with high dosages of prednisolone, she died of multiple metastases due to the breast cancer.