A 62-year-old man presents with a two-month history of painful, erosive stomatitis and conjunctivitis. He also has a polymorphous skin eruption consisting of flaccid blisters, targetoid lesions, and lichenoid papules over the trunk and palms. A biopsy shows suprabasal acantholysis and interface dermatitis with necrotic keratinocytes. Which underlying malignancy is most strongly associated with this condition?
- A Chronic lymphocytic leukemia ✓
- B Adenocarcinoma of the lung
- C Renal cell carcinoma
- D Hepatocellular carcinoma
Correct answer: A. Chronic lymphocytic leukemia
Explanation
Paraneoplastic pemphigus is strongly associated with lymphoproliferative malignancies, most commonly chronic lymphocytic leukemia, non-Hodgkin lymphoma, and Castleman disease. The clinical hallmark is painful mucosal erosions and a polymorphous skin eruption. Histology uniquely shows a combination of suprabasal acantholysis and interface dermatitis. Lung adenocarcinoma, renal cell carcinoma, and hepatocellular carcinoma are not typical underlying malignancies for this condition.
Reference: Bolognia's Dermatology, 4th ed.
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