A 65-year-old female presented to the outpatient department with a chief complaint of persistent soreness in the mouth.
She had been wearing complete dentures for the past 10 years. On intraoral examination, multiple small vesicles coalescing into bullae were observed over the hard palate and right maxillary buccal alveolar ridge. The bullae ruptured easily, leaving painful erosions.
The initial clinical impression was denture-induced stomatitis. She was advised to discontinue denture use and was prescribed an antifungal medication along with an antifungal mouthwash.
The patient returned 5 days later with persistent soreness and no significant improvement.
A detailed medical history revealed:
- Type 2 diabetes mellitus.
- Similar recurrent pain involving the vaginal mucosa, associated with burning during micturition.
- History of receiving systemic corticosteroid therapy approximately 2 months earlier for similar complaints.
An incisional biopsy was performed.
Histopathological examination revealed a subepithelial cleft with separation at the basement membrane zone, accompanied by a chronic inflammatory cell infiltrate containing eosinophils.
Direct immunofluorescence (DIF) demonstrated linear deposition of IgG and C3 along the basement membrane zone.
Based on the clinical presentation and the biopsy findings, what is your final diagnosis?
A. Denture-induced stomatitis
B. Chronic atrophic candidiasis
C. Mucous membrane (cicatricial) pemphigoid
D. Pemphigus vulgaris
What key histopathological and immunofluorescence findings helped you reach your diagnosis?
MBH/PS