Background: Pemphigus Vulgaris (PV) is an autoimmune bullous disorder that usually affected the middle-aged and elderly. PV management in elderly patients is still a challenge for clinicians because of an increased risk of developing diabetes in the elderly. Corticosteroid is the first-line treatment for PV; however, careful consideration should be taken for diabetes patients due to the risk of disrupting glucose control leading to acute decompensation.
Case: A seventy-year-old female with type II diabetes reported to Sanglah General Hospital with multiple painful blisters on the chest, back, and oral mucous. She has been treated with insulin since last year, but the treatment was non-compliant. Dermatological examination showed multiple flaccid bullae containing serous fluid with a positive Nikolsky sign, and multiple skin erosions. Histopathology finding is appropriate with PV. The Tzank smear examination revealed acantholytic cells. She was diagnosed with PV and typed II diabetes; therefore, we treated her with azathioprine, insulin and Lantus injection; sodium chloride 0.9% compress and fusidic acid cream 2% twice daily for topical treatment.
Conclusion: Azathioprine is the treatment of choice because it works by blocking DNA replication without increasing blood glucose levels. The selection of appropriate medications can improve patient prognosis.