Pemphigus Vulgaris Diagnosis — NDEB AFK MCQ

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HardOral PathologyPemphigus Vulgaris DiagnosisNDEB AFK

A positive Nikolsky sign with intraepithelial (suprabasilar) acantholysis on biopsy and a 'fishnet' pattern on direct immunofluorescence (IgG and C3 deposited in the intercellular spaces) is diagnostic of which condition?

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Correct answer: D — Pemphigus vulgaris

Pemphigus vulgaris is characterised by autoantibodies (IgG) directed against desmoglein 3 (and sometimes desmoglein 1), causing acantholysis (loss of cell-to-cell adhesion) within the spinous layer (suprabasilar). Direct immunofluorescence shows a characteristic 'fishnet' or 'chicken wire' pattern of IgG and C3 deposits in the intercellular spaces of the epithelium. Oral lesions (painful erosions/ulcers) often precede skin involvement and are the presenting feature in >50% of cases.

Reference: Neville – Oral and Maxillofacial Pathology, 4th ed., 2016