We report the case of a 56-year-old woman who presented with a.-month histo
ry of widespread oral erosion and a 3-day history of small papules on the l
ower eyelids. No other skin involvement was found. Histopathological examin
ation revealed suprabasal cleft and acantholysis in the lower epidermis of
the papule on the lower eyelid and in the lower mucous membrane of the oral
mucosa, Intercellular deposits of IgG and C3 were seen in the whole epider
mis of the specimen from the papule on the right lower eyelid by direct imm
unofluorescence study. These deposits were also observed in the biopsy spec
imen from erosion on the left buccal membrane. Indirect immunofluorescence
study using normal human skin as a substrate showed intercellular antibodie
s directed to the cell surface of the whole epidermis with a titer of 1:40.
The titers of antibodies to desmoglein 3 and 1 were 118 and 25.9, respecti
vely, by enzyme-linked immunosorbent assay, The patient was treated with an
oral administration of prednisolone (0.75 mg/kg/day) for 9 days, which imp
roved the skin eruptions and oral erosion. The dose of prednisolone was gra
dually tapered and it took 10 weeks to cease this treatment. These findings
suggest that this patient is an unusual case of pemphigus vulgaris (mucosa
l dominant type) diagnosed from the clinical and histopathological findings
, with positive antibodies to desmoglein 3 and 1.