Image Article Esophageal Nikolsky Sign in Bullous Pemphigus
by Veera Durga Vaishnavi Kurra1, Satya Sai Venkata Lakshmi Arepalli1, Ajayi Tokumbo1, R. Hal Scofield1,2,3*
1Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA
2US Department of Veterans Affairs Medical Center, USA
3Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
*Corresponding Author: Hal Scofield, Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, 825 NE 13th Street, Oklahoma City, OK 73104, USA
Received Date: 19 November 2025
Accepted Date: 24 November 2025
Published Date: 26 November 2025
Citation: Kurra VDV, Arepalli SSVL, Tokumbo A, Scofield RH. (2025). Esophageal Nikolsky Sign in Bullous Pemphigus. Ann Case Report. 10: 2454. DOI: https://doi.org/10.29011/2574-7754.102454
Clinical Presentation
A 77-year-old woman with bullous pemphigoid (BP) presented to the emergency department with dysphagia and was admitted. Skin lesions were typical of BP. She was unable to eat or drink. Esophagogastroduodenoscopy showed no abnormalities on endoscope entry (Panel A), however, on endoscope withdrawal, there were new blebs (arrows Panels B,C), which were consistent with esophageal Nikolsky sign. Nikolsky sign is usually found in the skin after pressure disrupts epidermal-dermal adhesion. The differential diagnosis includes blistering skin diseases, staphylococcus scalded skin syndrome and erythema multiforme. Nikolsky sign in the esophagus is a rare finding in bullous pemphigus, but up to 5% of patients have esophageal involvement. Thus, esophageal BP should be considered in patients with GI symptoms. She received doxycycline, topical glucocorticoid, and nicotinamide; her symptoms improved, and she tolerated a soft diet. Two months in clinic later she had no dysphagia.
Figure 1: Panel A, Panel B, Panel C
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