title: Three cases of pemphigus vegetans: induction by enalapril--association with internal malignancy.
abstract: BACKGROUND
  Pemphigus vegetans, a rare form of pemphigus vulgaris, consists of vegetating plaques localized to flexural areas. Two types, the Neumann and the Hallopeau type, are recognized with their own characteristics.
  
  
  METHODS
  Three patients with pemphigus vegetans were examined, two with Hallopeau type and one with Neumann type. The microscopic and immunofluorescence findings were recorded.
  
  
  RESULTS
  Two remarkable features were present. In one case pemphigus vegetans was possibly induced by the use of enalapril. Only in three previous cases has enalapril been described in relation to pemphigus. A second case was associated with a malignant lung tumor, a phenomenon which could not be traced in the literature.
  
  
  CONCLUSIONS
  Two types of pemphigus vegetans must be distinguished. Induction of pemphigus (also vegetans) is an accepted side effect of captopril. The effect of enalapril on pemphigus is still in debate. To the best of our knowledge, this is the first time that a patient with pemphigus vegetans and a simultaneously occurring internal malignancy is described.
authors.affiliation: Department of Dermatology, Free University Hospital, Amsterdam, The Netherlands.
authors.forename: M T
authors.initials: MT
authors.lastname: Bastiaens
authors.forename: N V
authors.initials: NV
authors.lastname: Zwan
authors.forename: G L
authors.initials: GL
authors.lastname: Verschueren
authors.forename: T J
authors.initials: TJ
authors.lastname: Stoof
authors.forename: C
authors.initials: C
authors.lastname: Nieboer
mesh_terms: D000368:Aged; D001262:Atenolol / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000473:pathology; D004656:Enalapril / Q000009:adverse effects*; D004804:Eosinophils / Q000473:pathology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications*; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000139:chemically induced / Q000473:pathology; D010392:Pemphigus / Q000139:chemically induced* / Q000209:etiology* / Q000473:pathology
chemical_list: D001262:Atenolol; D004656:Enalapril