{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:26:25Z","timestamp":1787318785409,"version":"build-2736575974"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Pemphigus vulgaris (PV) is a chronic autoimmune blistering disease characterized by intraepidermal flaccid blisters of the skin and mucous membranes. Although typically chronic and relapsing, rare fulminant variants have been described. We report a life-threatening case of PV in a previously healthy 55-year-old woman who developed a rapidly progressive, Stevens\u2013Johnson syndrome\/toxic epidermal necrolysis (SJS\/TEN)-like phenotype with extensive epidermal detachment and mucocutaneous involvement. Histopathological analysis demonstrated suprabasal acantholysis, and direct immunofluorescence showed intercellular IgG and C3 deposition. Serology revealed markedly elevated anti\u2013Desmoglein-1 (107.5 IU\/mL) and modest anti\u2013Desmoglein-3 titers (9.6 IU\/mL). The clinical course was complicated by Cytomegalovirus reactivation, while malignancy screening remained negative. Treatment with rituximab and intravenous immunoglobulin led to rapid re-epithelialization and clinical stabilization. This case expands the clinical spectrum of PV and underscores diagnostic and therapeutic challenges posed by fulminant autoimmune blistering disease exhibiting overlapping features. As rat-bladder indirect immunofluorescence and extended plakin serology were not available, a paraneoplastic pemphigus (PNP)-spectrum disorder could not be formally excluded, although the clinical, histological, and serological picture strongly favored PV. We propose that markedly elevated anti-Dsg1 antibodies, complement activation, and CMV reactivation may each have contributed to this severe phenotype.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1907863","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:39:18Z","timestamp":1787315958000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case report: Atypical SJS\/TEN-like fulminant pemphigus vulgaris: diagnostic challenges and the potential impact of anti-Dsg1 titers and CMV reactivation"],"prefix":"10.3389","volume":"17","author":[{"given":"Alice","family":"Verdelli","sequence":"first","affiliation":[{"name":"Rare Skin Diseases Unit, Section of Dermatology, Department of Health Sciences, ERN-SKIN Member, University of Florence","place":["Florence, 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