Paudel, Vikash2025-09-232025-09-232022https://hdl.handle.net/20.500.14572/2302Vikash Paudel National Medical College and Teaching Hospital, Birgunj, Nepal https://orcid.org/0000-0001-8729-052XAbstract: Pemphigus vulgaris is an autoimmune blistering disorder where biologics are the cornerstone of therapy. In resource-limited settings, a dermatologist should rely on systemic steroids. Dexamethasone pulse therapy is a cheap and established treatment of pemphigus where a supra-pharmacological dose of dexamethasone is used. High dose of dexamethasone is supposed to have atherogenic potential which could promote a hypercoagulable state. Here, we report a case of a 30-year-old woman in the resource-limited setting of Nepal, who was under monthly dexamethasone pulse therapy for pemphigus vulgaris, who had an acute episode of ST-segment elevated myocardial infarction. In such setting, although steroids are the cornerstone of therapy in various disorders, physicians should be equally cautious in using a high dose of steroids which might lead to fatal complications. This could probably be the first case report of steroid-induced acute myocardial infarction during treatment of pemphigus worldwide.en-USDexamethasoneMyocardial InfarctionPemphigus vulgarisPulse therapyArticle