Autoimmune pemphigus: diagnostic challenges, interdisciplinary interaction, and therapeutic errors

Patient safety is a fundamental principle in the provision of medical care. In the Russian Federation, continuous efforts are undertaken to reduce the number of adverse events, including through systematic analysis of medical errors and undesirable incidents. To illustrate these issues, the article presents four clinical cases of patients with various forms of acantholytic pemphigus. Particular attention is given to the young age of the patients and the clinical course of specific forms of acantholytic pemphigus. The paper discusses shortcomings in medical care, including violations of differential diagnostic algorithms, lack of interdisciplinary continuity, and therapeutic strategy failures. It is reported that diagnostic and therapeutic errors contribute to a more severe course of dermatosis and the transformation of one pemphigus form into another.

Timely diagnosis of pemphigus, which belongs to the group of autoimmune bullous dermatoses, is a crucial step in patient management and prevents progression of autoimmune forms in the absence of pathogenetic therapy. Diagnostic criteria include medical history, clinical presentation, cytological examination for acantholytic cells from the base of mucosal and/or skin erosions, histopathological examination of skin biopsy samples from lesions (including direct immunofluorescence methods), and/or indirect immunofluorescence testing of serum to detect IgG and IgA autoantibodies.

The article emphasizes the importance of adherence to clinical guidelines, increasing awareness among physicians of related specialties about current features of bullous dermatoses, and improving coordination among specialists from different disciplines. Addressing these issues will improve the quality of medical care and enhance patient safety.