Pemphigus Vulgaris Presenting with Initial Dermatological Manifestations and Occult Laryngeal Involvement: A Rare ENT-Dermatology Correlated Case

Pemphigus vulgaris is a rare, potentially life-threatening autoimmune blistering disorder predominantly affecting the skin and oral mucosa. Laryngeal involvement is uncommon and often underdiagnosed due to subtle or nonspecific symptoms. We report a case of a 38-year-old female who presented with classical cutaneous and oral manifestations of pemphigus vulgaris and was incidentally found to have occult laryngeal involvement on otorhinolaryngological evaluation. Dermatological investigations including Tzanck smear, histopathology, and direct immunofluorescence confirmed the diagnosis. Flexible fiberoptic laryngoscopy revealed superficial erosions over the supraglottic structures without airway compromise. Early initiation of systemic corticosteroids and rituximab led to rapid clinical remission of both cutaneous and laryngeal lesions. This case highlights the importance of a high index of suspicion and routine ENT evaluation in patients with pemphigus vulgaris, even in the presence of minimal laryngeal symptoms, to prevent potentially life-threatening airway complications. Close interdisciplinary collaboration ensures early diagnosis and favorable outcomes.