Pemphigus vulgaris localized to the vagina presenting as chronic vaginal discharge

involvement in pemphigus vulgaris of the female genital tract including the vulva, vagina and cervix has previously been described. In all these cases Ether cutaneous and mucosal sites have also been affected at some time. We describe a case of pemphigus vulgaris which only involved the vaginal muco sa, The patient presented with a persistent vaginal discharge and examinati on showed extensive vaginal erosions. Histology of vaginal biopsies was non -diagnostic. The recognition that the vaginal changes map represent an immu nobullous disease led to further vaginal biopsies on which direct immunoflu orescence studies were performed, These biopsies showed IgG and C3 in the i ntercellular epidermis, suggesting a diagnosis of pemphigus vulgaris. Durin g the 3-year period that the patient has been under review there have never been any other cutaneous or mucosal lesions. To our knowledge, this is the first case of pemphigus vulgaris localized exclusively to the vaginal muco sa, There was considerable delay in diagnosis and this case highlights how important it is to recognize that chronic mucosal lesions at genital sites may be caused by immunobullous diseases such as cicatricial pemphigoid and pemphigus, and to institute appropriate investigations.