eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2024-08-25 12 8 121 123 10.12691/ajmcr-12-8-4 AJMCR20241284 article Gabriel Riguerio 1 2 Folake Ishola folakeishola26@gmail.com 2 Cameron Stepler 2 Leah Gehring 2 Department of Internal Medicine, Ascension St. Vincent Hospital Indianapolis, Indiana, USA Pemphigus vulgaris is a rare autoimmune disorder affecting the cell to cell adhesion molecules of keratinocytes in the epidermis and mucosa resulting in the production of the classic blister formation. This disease classically presents with intraoral blisters that may rupture and leave painful erosions impairing nutritional intake of patients. We present a case of a male in his early 40s noted to be earlier than the typical age of onset of Pemphigus Vulgaris. The patient had an atypical presentation of his lesions initially starting on his scalp rather than the typical oral involvement with bullous lesions at onset. Our case highlights the increasing incidence of malnutrition in patients with this condition. Our patient was found to have vitamin D insufficiency noting the association of Pemphigus Vulgaris with hypovitaminosis D with the call to action to include vitamin D screening in suspected or confirmed cases of Pemphigus Vulgaris. After discovering this patient¡¯s primary diagnosis with punch biopsies, he was immediately started on a treatment regimen including corticosteroids and Vitamin D supplementation. The objective of this case report is to highlight this patient¡¯s early onset of this disease as well as his atypical presentation. Additionally, we want to emphasize the association between Pemphigus Vulgaris and hypovitaminosis D to decrease the risk of further complications such as osteoporosis or life threatening injuries. https://pubs.sciepub.com/ajmcr/12/8/4/ajmcr-12-8-4.pdf hypovitaminosis d vitamin d deficiency malnutrition acantholysis blisters desmoglein autoimmune pemphigus vulgaris pemphigus