Pemphigus Vulgaris: Bilateral Plica Semilunaris Involvement

Purpose: To present a case of pemphigus vulgaris, involving the conjunctiva, specifically the plica semilunaris, in both eyes of a 33-year-old woman. Methods: Ocular evaluation showed bilateral plica semilunaris vegetations extending for 3 mm linearly. Sequential excisional biopsies of both affected plica were performed and sent for pathological examination and immunofluorescent staining. Results: After each excisional biopsy, the patient's ocular symptoms resolved. Excisional biopsies showed suprabasilar clefting within the epithelium; lymphoplasmacytic infiltration and immunopathology showed intraepithelial intercellular and basement membrane zone staining with immunoglobulin G consistent with pemphigus vulgaris. At 1-year follow-up, the patient continues to be asymptomatic with no signs of recurrence. Conclusions: Excisional biopsy, in a very symptomatic patient with pemphigus vulgaris with conjunctival vegetations, may hasten his or her recovery.