Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Pelvic Inflammatory Disease Pemphigus Vulgaris and Pemphigus Foliaceus 1149

■Ofloxacin: side effects: GI intolerance, CNS stimulation, dizziness;

contraindicated in pregnancy (C) and patients < 18 years

follow-up

■Must re-examine patients receiving outpatient care in 24–72 h; if no

clinical improvement pursue additional diagnostic tests, hospital-

ization, surgical intervention; if improving, continue follow-up at 7

and 21 days

■Consider re-screening for GC and CT 4–6 weeks after completion of

therapy with cervical cultures and/or non-culture assays

complications and prognosis

■Perihepatitis: inflammation of liver capsule and adjacent peri-

toneum; presents with RUQ pain, LFTs usually normal; occurs in

5–15% of patients with acute salpingitis

■25% of cases experience long-term sequelae (tubal infertility, ectopic

pregnancy, chronic pelvic pain); increased risk with severe disease

and repeated infections; decreased risk if antibiotics are started

within 3 days of symptom onset

■Mortality is rare, usually occurs with ruptured tubo-ovarian abscess

(mortality 3–8%)

PEMPHIGUS VULGARIS AND PEMPHIGUS FOLIACEUS

DANIEL J. SHEEHAN, MD; ROBERT SWERLICK, MD; and

JEFFREY P. CALLEN, MD

history & physical

■Mucosal erosions and ulcerations are the most common initial man-

ifestation in pemphigus vulgaris.

■Flaccid bullae or erosions or crusted skin lesions may occur initially

in pemphigus foliaceus and following oral lesions in pemphigus vul-

garis.

■Pemphigus foliaceus does not involve the mucous membranes and

often follows a seborrheic distribution.

tests

Basic Blood Tests

■Electrolytes

Specific Diagnostic Tests

■Skin biopsy from small bulla or margin of larger bulla shows intra-

epidermal blistering