{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T06:26:16Z","timestamp":1765261576629,"version":"3.46.0"},"reference-count":18,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010256","name":"Guangzhou Municipal Science and Technology Project","doi-asserted-by":"publisher","award":["2024A03J0022"],"award-info":[{"award-number":["2024A03J0022"]}],"id":[{"id":"10.13039\/501100010256","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82405509"],"award-info":[{"award-number":["82405509"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Paraneoplastic pemphigus (PNP) is a rare autoimmune disorder typically associated with hematologic or squamous cell malignancies. Its association with lung adenocarcinoma (LUAD) is exceptionally uncommon, with only sporadic cases reported. This report highlights PNP as a sentinel manifestation of occult LUAD, emphasizing diagnostic challenges and therapeutic implications in this underrecognized association. A 73\u2010year\u2010old Asian woman presented with refractory mucocutaneous erosions, confirmed as PNP through histopathology (intraepidermal acantholysis), direct immunofluorescence (IgG\/C3 deposits), and elevated anti\u2010desmoglein\u20103 antibodies (172\u2009U\/mL). Persistent symptoms prompted malignancy screening, which revealed stage IA EGFR\u2010mutated LUAD. Initial immunosuppression (corticosteroids, intravenous immunoglobulin) failed to control disease. Tumor resection induced transient remission, but postoperative recurrence required rituximab therapy, achieving sustained clinical and serologic improvement (anti\u2010Dsg3 decline to 60\u2009U\/mL). This case expands the known malignancy spectrum of PNP to include LUAD and underscores the necessity of rigorous tumor screening even in atypical presentations. The temporal correlation between tumor resection, rituximab response, and autoantibody decline supports synergistic neoplastic\/immune mechanisms. Persistent B\u2010cell activity post\u2010resection suggests adjunctive immunomodulation is critical for durable remission. Our findings advocate for (1) multidisciplinary collaboration to address diagnostic pitfalls (e.g., lesion mimicry, delayed tumor detection) and (2) consideration of rituximab in refractory PNP with solid tumors.<\/jats:p>","DOI":"10.1002\/ccr3.71386","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:04:59Z","timestamp":1761894299000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Paraneoplastic Pemphigus Unveiling Occult Lung Adenocarcinoma: A Rituximab\u2010Responsive Case With Diagnostic and Therapeutic Implications"],"prefix":"10.1002","volume":"13","author":[{"given":"Yongfeng","family":"Li","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine  Guangzhou Guangdong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haochuan","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Oncology The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine  Guangzhou Guangdong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinsheng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Dermatology The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine  Guangzhou Guangdong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yihong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Oncology The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine  Guangzhou Guangdong 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China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liting","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine  Guangzhou Guangdong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuyun","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine  Guangzhou Guangdong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2624-3398","authenticated-orcid":false,"given":"Jicai","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine  Guangzhou Guangdong 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