A number of dermatologic conditions may have associated esophageal manifestations. Teleologically, this may be because both the skin and the esophagus are lined by stratified squamous epithelium. Bullous dermatoses that may produce blisters, erosions, and/or stricture of the esophagus include cicatricial pemphigoid, Hailey-Hailey disease, Darier's disease, various forms of epidermolysis bullosa, bullous pemphigoid, and pemphigus vulgaris. Very rarely, bullous diseases may affect the esophagus in such a manner that there is a sloughing of the entire mucous membrane. The production of such an esophageal cast has been termed esophagitis dissecans superficialis. This is the second case recorded in the medical literature of pemphigus vulgaris associated with esophagitis dissecans superficialis. Additionally, this is the first case of pemphigus vulgaris in which the esophagus is demonstrated to be positive by direct immunofluorescence.