Oral mucous membrane pemphigoid as a window to systemic autoimmunity: two cases associated with rheumatoid arthritis and Sjögren's disease.
Isabella Castro de Oliveira, Laura Silva Dos Santos, Jessica Dos Santos Rodrigues et al.
✦ AI-curated · Sources linked
Case in brief
Two women presented with oral mucous membrane pemphigoid (MMP) in the setting of systemic autoimmunity. A 68-year-old woman with longstanding rheumatoid arthritis had recurrent oral ulcerations confirmed as MMP on histopathology; follow-up also identified rheumatoid arthritis–related peripheral ulcerative keratitis. Rituximab controlled both the ocular rheumatoid arthritis manifestation and MMP activity. A 44-year-old woman presented with desquamative gingivitis and oral bullous lesions, with biopsy confirming MMP. Progressive sicca symptoms led to a diagnosis of Sjögren's disease based on serology, imaging, and minor salivary gland biopsy; azathioprine stabilized both conditions.
What made this case unusual
In one case, oral MMP accompanied rheumatoid arthritis with peripheral ulcerative keratitis; in the other, MMP preceded recognition of Sjögren's disease as sicca symptoms progressed.
Diagnostic / clinical pearl
Biopsy-confirmed oral MMP should prompt attention to coexisting or evolving systemic autoimmune disease, particularly when ocular manifestations or progressive sicca symptoms are present.
Why it matters
The cases show that coordinated rheumatological and oral assessment can identify overlapping autoimmune conditions and inform therapy that controls more than one disease.