In vivo optical coherence tomography imaging in a case of mucous membrane pemphigoid and a negative Nikolsky's sign

There is currently a growing interest in new diagnostic tools of the oral cavity and mucosa which are non-invasive,repeatable and reliable. A diagnosis of a suspected, autoimmune pathology was made regarding a 57-yearoldpatient with desquamative gingivitis. However, a negative Nikolsky’s sign did not seem to indicate a diagnosisof mucous membrane pemphigoid neither was there any indication as to the optimum location for an incisionalbiopsy. As an imaging method, the use of optical coherence tomography (OCT) has enabled the obtaining oftomographic (cross-sectional) scans of tissue. Such images are acquired prior to and after verifying Nikolsky’ssign, thereby enabling the clinician to identify the presence (or not) of subepithelial bullae. Thereafter, an assessmentof changes in the subepithelium (the split) can be performed, even in the absence of a suitable clinical picture,such as, for example, a negative Nikolsky’s sign. Histological analysis and the use of indirectimmunofluorescence have facilitated a diagnosis of mucous membrane pemphigoid, an autoimmune pathology,which can be confirmed with the appearance of subepithelial bullae. OCT was found to be a valid, non-invasive,auxiliary diagnostic device, capable of revealing in vivo and real-time bullae, which were hitherto clinically undetectable.