Pênfigo Vulgar Oral em Idosa: Condutas de um Caso Desafiador Oral Pemphigus Vulgaris in Old Woman: Conducts of a Challenging Case
##plugins.themes.bootstrap3.article.sidebar##
Publicado:
Mai 12, 2021
Palavras-chave:
Pênfigo, Doenças Autoimunes, Mucosa Bucal
##plugins.themes.bootstrap3.article.main##
Resumo
A doença pênfigo é uma enfermidade autoimune que dependendo do nível de acometimento epitelial, pode ser classificada em pênfigo vulgar, vegetante, eritematoso e foliáceo. Além desses, há também o denominado pênfigo paraneoplásico, que ocorre especialmente em casos que há vínculo a neoplasias malignas com destaque para os linfomas. Somente os tipos vulgar e vegetante podem afetar a mucosa oral, sendo o pênfigo vulgar o mais prevalente. O mecanismo fisiopatológico da doença é caracterizado pela ação de autoanticorpos contra as proteínas desmogleínas dos desmossomos encontrados nas células epiteliais, desencadeando assim, a formação de fendas intraepiteliais e bolhas. O manejo dos pacientes com pênfigo vulgar oral é bastante desafiador, especialmente em casos de indivíduos idosos e portadores de comorbidades. O presente trabalho objetiva discutir aspectos contemporâneos do pênfigo vulgar oral e elucidar o caso de uma idosa acometida pela doença, destacando toda a propedêutica utilizada no seu atendimento e o tratamento empregado, com o uso de corticoides sistêmicos e acompanhamento constante da condição da paciente, uma vez que o pênfigo vulgar é uma doença que não tem cura.
##plugins.themes.bootstrap3.article.details##
Como Citar
Cesar Guimarães Henriques, J., Rodrigues de Oliveira, J., do Carmo Faleiros Veloso Guedes, C., & Alves da Rocha, M. (2021). Pênfigo Vulgar Oral em Idosa: Condutas de um Caso Desafiador. Revista Naval De Odontologia, 48(I), 16-23. https://doi.org/10.29327/25149.48.1-2
Seção
Relatos de caso
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Referências
1. Neville BW, Damm DD, Allen CM, Bouquot JE. Patologia
oral e maxilofacial. Pênfigo. Elsevier editora; 2009. p. 767- 771.
2. Kasperkiewicz M, Ellebrecht CT, Takahashi H, Yamagami J,
Zillikens D, Payne, AS, et al. Pemphigus. Nat Rev Dis Primers
3(1):1-18.
3. Ben Lagha N, Poulesquen V, Roujeau JC, Alantar A, Maman L. Pemphigus vulgaris: a case-based update. J Can Dent Assoc.
2005 Oct;71(9):667-72.
4. Porro AM, Seque CA, Ferreira MCC, Enokihara MMSS.
Pemphigus vulgaris. An. Bras. Dermatol. 94(3):264-278.
5. Wojnarowska F, Venning VA. Immunobullous Diseases.
Rook’S Textbook Of Dermatology, Wiley-Blackwell; 2010. p.
1-62.
6. Parameswaran A, Attwood K, Sato R, Seiffert-Sinha K, Sinha
AA. Identification of a new disease cluster of pemphigus
vulgaris with autoimmune thyroid disease, rheumatoid
arthritis and type I diabetes. Br J Dermatol. 2015;172(3):729-
38.
7. Arbabi M, Ghodsi Z, Mahdanian A, Noormohammadi
N, Shalileh K, Darvish F, et al. Mental health in patients
with pemphigus: an issue to worth consideration. Indian J
Dermatol Venereol Leprol. 2011;56(5):541-5.
8. Ambiel MV, Roselino AM. Prevalence of Metabolic
Syndrome and its components in a Brazilian sample of
pemphigus patients. An Bras Dermatol. 2014;89(5):752-6.
9.Tsunoda K, Ota T, Saito M, Hata T, Shimizu A, Ishiko A, et
al. Pathogenic relevance of IgG and IgM antibodies against
desmoglein 3 in blister formation in pemphigus vulgaris. Am J
Pathol. 2011;179(2):795-806.
10. Hammers CM, Stanley JR. Mechanisms of Disease:
Pemphigus and Bullous Pemphigoid. Annu Rev Pathol.
2016;11:175-97.
11. Di Zenzo G, Amber KT, Sayar BS, Muller EJ, Borradori L.
Immune response in pemphigus and beyond: progresses and
emerging concepts. Semin Immunopathol. 2016;38(1):57-74.
12. Pan M, Liu X, Zheng J. The pathogenic role of autoantibodies
in pemphigus vulgaris. Clin Exp Dermatol. 2011;36(7):703-7.
13. Joly P, Litrowski N. Pemphigus group (vulgaris, vegetans,
foliaceus, herpetiformis, brasiliensis). Clin Dermatol.
2011;29(4):432-6.
14. Bystryn JC, Rudolph JL. Pemphigus. Lancet.
2005;366(9479):61-73.
15. Mustafa MB, Porter SR, Smoller BR, Sitaru C. Oral mucosal
manifestations of autoimmune skin diseases. Autoimmun Rev.
2015;14(10):930-51.
16. Ganapati S. Eponymous dermatological signs in
bullous dermatoses. Indian J Dermatol Venereol Leprol.
2014;59(1):21-3.
17. Ohta M, Osawa S, Endo H, Kuyama K, Yamamoto H, Ito
T. Pemphigus vulgaris confined to the gingiva: a case report.
International journal of dentistry. 2011;2011:207153.
18. Dagistan S, Goregen M, Miloglu O, Cakur B. Oral pemphigus
vulgaris: a case report with review of the literature. J. Oral Sc.
2008;50(3):359-62.
19. Santos TS, Piva MR, Kumar PN, Martins Filho PRS,
Reinheimer DM, Acevedo CR. Importância do cirurgiãodentista
no diagnóstico precoce do pênfigo vulgar. RGO.
2009;57(3):5.
20. Tavakolpour S. Current and future treatment options
for pemphigus: Is it time to move towards more effective
treatments? Int Immunopharmacol. 2017;53:133-42.
21. Hertl M, Jedlickova H, Karpati S, Marinovic B, Uzun S, Yayli
S, et al. Pemphigus. S2 Guideline for diagnosis and treatment-
-guided by the European Dermatology Forum (EDF) in
cooperation with the European Academy of Dermatology
and Venereology (EADV). J Eur Acad Dermatol Venereol.
2015;29(3):405-414.
22. Bystryn JC, Steinman NM. The adjuvant therapy
of pemphigus. An update. Archives of dermatology.
1996;132(2):203-12.
23. Kridin K. Pemphigus group: overview, epidemiology,
mortality, and comorbidities. Immunologic research.
2018;66(2):255-70.
24. Pollmann R, Schmidt T, Eming R, Hertl M. Pemphigus:
a Comprehensive Review on Pathogenesis, Clinical
Presentation and Novel Therapeutic Approaches. Clin Rev
Allergy Immunol. 2018;54(1):1-25.
25. Broussard KC, Leung TG, Moradi A, Thorne JE, Fine JD.
Autoimmune bullous diseases with skin and eye involvement:
Cicatricial pemphigoid, pemphigus vulgaris, and pemphigus
paraneoplastica. Clin Dermatol. 2016;34(2):205-13.
26. Amagai M, Tanikawa A, Shimizu T, Hashimoto T, Ikeda S,
Kurosawa M, et al. Japanese guidelines for the management
of pemphigus. J Dermatol. 2014 Jun;41(6):471-86.
27. Arpita R, Monica A, Venkatesh N, Atul S, Varun M. Oral
Pemphigus Vulgaris: Case Report. Ethiop J Health Sci.
2015;25(4):367-72.
28. Robati RM, Rahmati-Roodsari M, Dabir-Moghaddam
P, Farnaghi A, Mahboobi-rad F, Rahimi H, et al. Mucosal
manifestations of pemphigus vulgaris in ear, nose, and
throat; before and after treatment. J Am Acad Dermatol.
2012;67(6):249-52.
29. Hale EK, Bystryn JC. Laryngeal and nasal involvement in
pemphigus vulgaris. J Am Acad Dermatol. 2001;44(4):609-11.
30. Cholera M, Chainani-Wu N. Management of Pemphigus
Vulgaris. Advances in therapy. 2016;33(6):910-58.
oral e maxilofacial. Pênfigo. Elsevier editora; 2009. p. 767- 771.
2. Kasperkiewicz M, Ellebrecht CT, Takahashi H, Yamagami J,
Zillikens D, Payne, AS, et al. Pemphigus. Nat Rev Dis Primers
3(1):1-18.
3. Ben Lagha N, Poulesquen V, Roujeau JC, Alantar A, Maman L. Pemphigus vulgaris: a case-based update. J Can Dent Assoc.
2005 Oct;71(9):667-72.
4. Porro AM, Seque CA, Ferreira MCC, Enokihara MMSS.
Pemphigus vulgaris. An. Bras. Dermatol. 94(3):264-278.
5. Wojnarowska F, Venning VA. Immunobullous Diseases.
Rook’S Textbook Of Dermatology, Wiley-Blackwell; 2010. p.
1-62.
6. Parameswaran A, Attwood K, Sato R, Seiffert-Sinha K, Sinha
AA. Identification of a new disease cluster of pemphigus
vulgaris with autoimmune thyroid disease, rheumatoid
arthritis and type I diabetes. Br J Dermatol. 2015;172(3):729-
38.
7. Arbabi M, Ghodsi Z, Mahdanian A, Noormohammadi
N, Shalileh K, Darvish F, et al. Mental health in patients
with pemphigus: an issue to worth consideration. Indian J
Dermatol Venereol Leprol. 2011;56(5):541-5.
8. Ambiel MV, Roselino AM. Prevalence of Metabolic
Syndrome and its components in a Brazilian sample of
pemphigus patients. An Bras Dermatol. 2014;89(5):752-6.
9.Tsunoda K, Ota T, Saito M, Hata T, Shimizu A, Ishiko A, et
al. Pathogenic relevance of IgG and IgM antibodies against
desmoglein 3 in blister formation in pemphigus vulgaris. Am J
Pathol. 2011;179(2):795-806.
10. Hammers CM, Stanley JR. Mechanisms of Disease:
Pemphigus and Bullous Pemphigoid. Annu Rev Pathol.
2016;11:175-97.
11. Di Zenzo G, Amber KT, Sayar BS, Muller EJ, Borradori L.
Immune response in pemphigus and beyond: progresses and
emerging concepts. Semin Immunopathol. 2016;38(1):57-74.
12. Pan M, Liu X, Zheng J. The pathogenic role of autoantibodies
in pemphigus vulgaris. Clin Exp Dermatol. 2011;36(7):703-7.
13. Joly P, Litrowski N. Pemphigus group (vulgaris, vegetans,
foliaceus, herpetiformis, brasiliensis). Clin Dermatol.
2011;29(4):432-6.
14. Bystryn JC, Rudolph JL. Pemphigus. Lancet.
2005;366(9479):61-73.
15. Mustafa MB, Porter SR, Smoller BR, Sitaru C. Oral mucosal
manifestations of autoimmune skin diseases. Autoimmun Rev.
2015;14(10):930-51.
16. Ganapati S. Eponymous dermatological signs in
bullous dermatoses. Indian J Dermatol Venereol Leprol.
2014;59(1):21-3.
17. Ohta M, Osawa S, Endo H, Kuyama K, Yamamoto H, Ito
T. Pemphigus vulgaris confined to the gingiva: a case report.
International journal of dentistry. 2011;2011:207153.
18. Dagistan S, Goregen M, Miloglu O, Cakur B. Oral pemphigus
vulgaris: a case report with review of the literature. J. Oral Sc.
2008;50(3):359-62.
19. Santos TS, Piva MR, Kumar PN, Martins Filho PRS,
Reinheimer DM, Acevedo CR. Importância do cirurgiãodentista
no diagnóstico precoce do pênfigo vulgar. RGO.
2009;57(3):5.
20. Tavakolpour S. Current and future treatment options
for pemphigus: Is it time to move towards more effective
treatments? Int Immunopharmacol. 2017;53:133-42.
21. Hertl M, Jedlickova H, Karpati S, Marinovic B, Uzun S, Yayli
S, et al. Pemphigus. S2 Guideline for diagnosis and treatment-
-guided by the European Dermatology Forum (EDF) in
cooperation with the European Academy of Dermatology
and Venereology (EADV). J Eur Acad Dermatol Venereol.
2015;29(3):405-414.
22. Bystryn JC, Steinman NM. The adjuvant therapy
of pemphigus. An update. Archives of dermatology.
1996;132(2):203-12.
23. Kridin K. Pemphigus group: overview, epidemiology,
mortality, and comorbidities. Immunologic research.
2018;66(2):255-70.
24. Pollmann R, Schmidt T, Eming R, Hertl M. Pemphigus:
a Comprehensive Review on Pathogenesis, Clinical
Presentation and Novel Therapeutic Approaches. Clin Rev
Allergy Immunol. 2018;54(1):1-25.
25. Broussard KC, Leung TG, Moradi A, Thorne JE, Fine JD.
Autoimmune bullous diseases with skin and eye involvement:
Cicatricial pemphigoid, pemphigus vulgaris, and pemphigus
paraneoplastica. Clin Dermatol. 2016;34(2):205-13.
26. Amagai M, Tanikawa A, Shimizu T, Hashimoto T, Ikeda S,
Kurosawa M, et al. Japanese guidelines for the management
of pemphigus. J Dermatol. 2014 Jun;41(6):471-86.
27. Arpita R, Monica A, Venkatesh N, Atul S, Varun M. Oral
Pemphigus Vulgaris: Case Report. Ethiop J Health Sci.
2015;25(4):367-72.
28. Robati RM, Rahmati-Roodsari M, Dabir-Moghaddam
P, Farnaghi A, Mahboobi-rad F, Rahimi H, et al. Mucosal
manifestations of pemphigus vulgaris in ear, nose, and
throat; before and after treatment. J Am Acad Dermatol.
2012;67(6):249-52.
29. Hale EK, Bystryn JC. Laryngeal and nasal involvement in
pemphigus vulgaris. J Am Acad Dermatol. 2001;44(4):609-11.
30. Cholera M, Chainani-Wu N. Management of Pemphigus
Vulgaris. Advances in therapy. 2016;33(6):910-58.