217 Abstract Pemphigus Vulgaris is a chronic autoimmune mucocutaneous disease, in which oral lesions could be the frst site observed, although skin and other mucous membranes may also be affected. Clinically, the lesions are characterized by many painful blisters that rapidly rupture resulting in erosions and/or multiple ulcers in the oral mucosa and skin, which can be diffcult to differentiate from other vesiculobullous or ulcerative disorders. Many patients may be misdiagnosed and improperly treated for a long time. It is considered a serious chronic disease and its treatment represents a real therapeutic challenge. We present 8 case reports of pemphigus vulgaris, in which a thorough evaluation was made, recording patient age and sex, the location and extent of the lesions, their signs, symptoms and treatment, with emphasis on the diffculty of the diagnosis and clinical management of these patients. Key Words: Pemphigus vulgaris, autoimmune diseases, clinical manifestations, treatment The Importance of a Multidisciplinary Team to Management the Manifestations of Pemphigus Vulgaris: Eight Case Reports Carolina Amália Barcellos Silva 1 , Alessandra Dutra da Silva 2 , Maria Inês Meurer 3 , Filipe Modolo 3 , Liliane Janete Grando 3 1 Department of Oral Pathology, Universidade do Planalto Catarinense, Brazil. 2 Department of Oral Pathology, Universidade Federal do Rio Grande do Sul, Brazil, 3 Department of Pathology, Health Science Center, Universidade Federal de Santa Catarina, Brazil. Corresponding author: Liliane Janete Grando, Professor, Departmento de Patologia, Centro de Ciências da Saúde, Universidade, Federal de Santa Catarina, Rua Delfno Conti, s/n.Campus Universitário – Bairro Trindade,88040-900 Florianópolis, Brazil,Tel: + 55 48 3721-5068; E-mail: liliane.j.grando@ufsc.br Introduction Pemphigus Vulgaris (PV) is a chronic autoimmune mucocutaneous disease characterized by the production of autoantibodies directed against desmosome-associated protein antigens found in epithelial and epidermal intercellular substance, resulting in loss of coherence of the epidermal and mucosal epithelial structures, with subsequent blister formation [1,2]. PV is a rare disease, with a reported incidence of 0.1-0.5 cases per 100.000 individuals worldwide per year. It affects both sexes equally, though some authors have reported a greater incidence among women, and that is primarily manifests in adults during the ffth or sixth decade of the life [3-6]. Clinically, the lesions are characterized by many blisters that rapidly rupture resulting in very painful erosions and/or multiple ulcers in the oral mucosa and skin. Other mucous membranes such as the conjunctiva, nasal, and genital mucosa can also be affected. In most cases, the frst signs of disease appear in the oral mucosa and precede the cutaneous manifestation [3,7]. The diagnosis of PV is based on the combination of clinical and histopathological fndings. The most common symptoms that prompted patients to seek medical attention were pain and local discomfort, in addition to dysphagia and quick weight loss caused by lesions. The state of the patient's general health is seriously impaired by the disease, in some cases requiring admission to hospital [6]. The morphological view analyzed by the hematoxylin- eosine method shows the presence of intraepithelial blisters, acantholysis, and Tzanck´s cells. The direct immunofuorescence evaluation of fresh lesion specimens reveals IgG or IgM antibodies and complement fragments in the intercellular space located between epithelium cells [1,4,8]. PV was considered a fatal disease before the discovery of systemic corticosteroids. The mortality rate was 75% and most patients died within 5 years of disease onset. The systemic high-potency corticosteroids (Prednisone 40 to 80 mg/ daily) are the main drugs used in the treatment of PV. Other immunosuppressive agents (e.g.: Azathioprine, Cyclosporin, Mycophenolate Mofetil and intravenous Immunoglobulin infusion) are frequently used as adjuvant therapy and the choice of treatment depends on the disease severity [2,9,10]. All treatment has side effects, such as Cushing´s Syndrome, gastrointestinal disorders, hepatotoxicity, cataracts, osteoporosis, myopathy and renal toxicity. The treatment of PV is based on controlling the disease and not on curing the patient [6]. Thus, a multidisciplinary approach is needed, including dentists trained in the areas of the stomatology, oral pathology and medical professionals in the areas such as dermatology, gynecology, ophthalmology, psychologists and others. The treatment is long term requiring constant monitoring of the patient [6]. The aim of this study was to describe 08 case reports of Pemphigus Vulgaris, with emphasis on the diffculty of the diagnosis and clinical management of the patients. Case Reports Eight Caucasian patients (6 women and 2 men), with ages ranging from 37 to 74 years, were diagnosed with Pemphigus Vulgaris at the Stomatology Clinic of the University Hospital of the Federal University of Santa Catarina, State of Santa Catarina, Brazil. All patients gave their informed consent prior to their inclusion in the study. In no case had the lesions been present for more than six months at the time of the frst visit. The patients' main complaint was the oral pain, discomfort, and impairment of their normal oral functions. In the intraoral examination, all patients presented erosions and/or ulcers in the oral mucosa (Figure 1). A sensitive but nonspecifc clinical sign, Nikolsky's sign, in which the separation of the superfcial epithelial layers from the basal layer occurs on exertion of tangential pressure on the