Abstract
A patient with no reported past medical history presented to Jackson Memorial Hospital for 2-3 weeks with “red eyes”, ocular discharge, foreign body sensation, and various painful blisters on her oral mucosa and skin. She additionally endorsed occasional post-menopausal bleeding. Presenting visual acuity was 20/25 OD and 20/150 OS. Intraocular pressures were within normal limits. Direct immunofluorescence from a skin biopsy revealed linear positivity of IgG, IgA, and C3 at the basement membrane zone. CT abdomen and pelvis with contrast was performed to rule out hemorrhage as a source of the patient’s anemia, and pelvic lymphadenopathy was identified. Lymph node and endometrial biopsies were performed, which revealed stage IVB metastatic endometrial adenocarcinoma. A final diagnosis of paraneoplastic mucous membrane pemphigoid was established. The patient underwent various treatments including neoadjuvant chemotherapy with Carboplatin/Paclitaxel, intravenous steroids (up to 120mg/kg daily), oral steroids (up to 80mg daily), mycophenolate mofetil, rituximab, and intravenous immunoglobulin (IVIG). Rituximab and IVIG were found to be the most effective medications in improving the ocular and oral symptoms. Within seven months, the patient had deteriorated both from a systemic and ocular standpoint. Her visual acuity was light perception in both eyes, and both eyes had nearly completely cicatrized, with the left eye unable to be opened secondary to the severe scarring.
Presentation Date: 07/31/2025
Issue Date: 02/13/2026
