Skinternal Medicine: An Update on Cutaneous Manifestations of Systemic Disease

The presentation discusses the cutaneous manifestations of systemic disease, focusing on a case involving a 46-year-old man with newly diagnosed follicular lymphoma and painful oral lesions. Medications were ineffective, and various diagnostic tests were performed, including biopsies, immunofluorescent studies, and serological testing. The potential diagnosis considered was perineoplastic pemphigus, an autoimmune blistering disease associated with underlying malignancies, particularly lymphoproliferative disorders. This condition can lead to severe complications like bronchiolitis obliterans, characterized by respiratory failure due to airway obstruction and inflammation. The discussant emphasized the importance of recognizing perineoplastic pemphigus in patients with oral erosions linked to malignancies, even when serological tests are negative. The presentation highlighted the need for a combined therapeutic approach involving high-dose steroids, rituximab, and possibly other immunosuppressants, as outcomes remain poor and can lead to high mortality rates from infections or respiratory failure. Successful management requires close monitoring and collaboration with oncologists.