An unusual case of pemphigus vulgaris presenting as bilateral foot ulcers

We describe an unusual presentation of pemphigus vulgaris, an autoimmune in traepidermal blistering skin disease associated with autoantibodies to the desmosome glycoprotein, desmoglein 3. A 60-year-old man presented with bila teral ulceration on the dorsum of the feet. These clinical features persist ed for 4 months before more characteristic signs of pemphigus vulgaris, inc luding mouth ulceration and skin erosions, developed. The atypical presenta tion led to a delay in diagnosis and initiation of the appropriate treatmen t. Pemphigus vulgaris may have unusual manifestations, such as nail dystrop hy, paronychia, or granulation tissue-like lesions, but this case of bilate ral foot ulceration highlights a further, perhaps unique, clinical presenta tion of this autoimmune disease.