Pemphigus vulgaris (PV) is the most common autoimmune blistering disorder affecting the skin and mucous membranes. It is clinically characterized by the presence of flaccid vesiculobullous lesions or erosions, which usually start in the oral mucosa, followed by skin involvement. Atypical presentations of PV have been mentioned previously in the literature. Extensive bacterial overgrowth with staphylococcus aureus or Pseudomonas aeruginosa can lead to delayed wound healing and enlarging ulcers, thereby causing diagnostic problems. We describe an unusual presentation of PV masquerading as Ecthyma gangrenosum (EG) in a 55 year old male. © 2025 Elsevier B.V., All rights reserved.