A 45-year-old woman with pemphigus vulgaris on tapering prednisolone develops fever, rapidly enlarging crusted erosions with surrounding cellulitis, and pus from multiple lesions over 48 hours. Which complication poses the greatest immediate threat to life and demands urgent action?

• A Adrenal suppression causing hypoglycemia
• B Chronic renal failure from prolonged steroid therapy
• C Staphylococcus aureus septicemia arising from secondarily infected erosions ✓
• D Progression to pemphigus foliaceus

Explanation

Before the steroid era, septicemia from superinfected cutaneous erosions was the leading cause of death in pemphigus vulgaris, and it remains the dominant early killer during flares, particularly in patients on immunosuppression. Extensive eroded skin loses its barrier function and is readily colonized by Staphylococcus aureus. Options B and A are real consequences of chronic steroid use but develop insidiously over months, not within 48 hours, and pemphigus foliaceus is a different clinical variant rather than an acute threat.

Reference: Fitzpatrick's Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.