The emerging concern of oral pemphigus vulgaris arising post-COVID-19 infection: A case series

Abstract: Cases of coronavirus disease 2019 (COVID‑19) appear with a very diverse pattern of health manifestation, in  which the immune  system  plays  a  major  driver  of  severe  acute respiratory  syndrome  coronavirus 2  (SARS‑CoV‑2)  infection outcomes.  The  uncontrolled immune response of SARS‑CoV‑2 infection  could possibly  lead  to  autoimmune diseases,  as  we  observed  increased  cases  of  pemphigus vulgaris  (PV) post‑COVID‑19 infection. PV is an autoimmune life‑threatening mucocutaneous disease that is very rarely induced by certain drugs or substance. The link between COVID‑19 infection and autoimmune diseases is still unknown. This study outline the possible link with PV following infection of COVID‑19. A case series of  three  females  and one male between the ages of 33 and 57 with no history of drug‑induced illness or allergy were observed in our current case series. All patients previously contracted SARS‑CoV‑2. The lesions were treated with systemic and oral corticosteroid was given as a basic treatment for PV lesions. Immunomodulator agent was added as an  adjunct  to  reduce  the  effects of steroid  and to decrease the severity of PV. In conclusion, clinicians should be vigilant of the potential emergence of autoimmune reaction following the COVID‑19 pandemic. Further investigation is required to unfold the unclear mechanism of PV induced by SARS‑CoV‑2. We hypothesized that the genetic aberrance inferred by this viral infection might trigger autoimmune diseases and may not limit to PV.