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Severe multi-resistant pemphigus vulgaris: prolonged remission with a single cycle of rituximab.

Corral IS, Freitas TH, Aquino RT, Koller DA, Magliari ME, Muller H - An Bras Dermatol (2013 Jul-Aug)

Bottom Line: Male patient, 33 years old, diagnosed with pemphigus vulgaris, confirmed by histopathology and direct immunofluorescence.He was treated for seven months with numerous treatments, including immunosuppressive drugs, with an unsatisfactory response, until he had complete remission with the use of rituximab.During a 34-month follow-up period, the patient presented a slight clinical relapse, which was successfully controlled with prednisone in a daily dose of 120 mg, soon reduced to 20mg.

View Article: PubMed Central - PubMed

Affiliation: Dermatology Clinic, Santa Casa de Misericórdia de São Paulo, São Paulo(SP), Brazil.

ABSTRACT
Pemphigus vulgaris is an autoimmune bullous disease whose therapy is based on systemic corticosteroids, with or without immunosuppressants. Rituximab is a chimeric monoclonal antibody of the IgG class, directed at a specific CD20 B cell surface antigen, used in pemphigus vulgaris empirically since 2002, with success in 90% of the cases and long periods of remission. Male patient, 33 years old, diagnosed with pemphigus vulgaris, confirmed by histopathology and direct immunofluorescence. He was treated for seven months with numerous treatments, including immunosuppressive drugs, with an unsatisfactory response, until he had complete remission with the use of rituximab. During a 34-month follow-up period, the patient presented a slight clinical relapse, which was successfully controlled with prednisone in a daily dose of 120 mg, soon reduced to 20mg.

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01/05/2009 – Before rituximab
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f01: 01/05/2009 – Before rituximab

Mentions: Male patient, 33 years-old, without any morbid antecedents of notice, was admitted tothe hospital with a history of painful bullous lesions on the scalp and oral cavitysince two months before, with subsequent dissemination to the entire body. Physicalexamination showed flaccid blisters, mostly with serous content, besides exulceratedlesions covered in honey-colored crusts. (Figure1) The diagnostic hypothesis was pemphigus vulgaris, later confirmed by skinbiopsies and direct immunofluorescence. Treatment with prednisone 1mg/Kg/day andantibiotics to address the secondary infection was then started. The patient wasreleased 15 days later, with a slightly improved clinical condition.


Severe multi-resistant pemphigus vulgaris: prolonged remission with a single cycle of rituximab.

Corral IS, Freitas TH, Aquino RT, Koller DA, Magliari ME, Muller H - An Bras Dermatol (2013 Jul-Aug)

01/05/2009 – Before rituximab
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3760947&req=5

f01: 01/05/2009 – Before rituximab
Mentions: Male patient, 33 years-old, without any morbid antecedents of notice, was admitted tothe hospital with a history of painful bullous lesions on the scalp and oral cavitysince two months before, with subsequent dissemination to the entire body. Physicalexamination showed flaccid blisters, mostly with serous content, besides exulceratedlesions covered in honey-colored crusts. (Figure1) The diagnostic hypothesis was pemphigus vulgaris, later confirmed by skinbiopsies and direct immunofluorescence. Treatment with prednisone 1mg/Kg/day andantibiotics to address the secondary infection was then started. The patient wasreleased 15 days later, with a slightly improved clinical condition.

Bottom Line: Male patient, 33 years old, diagnosed with pemphigus vulgaris, confirmed by histopathology and direct immunofluorescence.He was treated for seven months with numerous treatments, including immunosuppressive drugs, with an unsatisfactory response, until he had complete remission with the use of rituximab.During a 34-month follow-up period, the patient presented a slight clinical relapse, which was successfully controlled with prednisone in a daily dose of 120 mg, soon reduced to 20mg.

View Article: PubMed Central - PubMed

Affiliation: Dermatology Clinic, Santa Casa de Misericórdia de São Paulo, São Paulo(SP), Brazil.

ABSTRACT
Pemphigus vulgaris is an autoimmune bullous disease whose therapy is based on systemic corticosteroids, with or without immunosuppressants. Rituximab is a chimeric monoclonal antibody of the IgG class, directed at a specific CD20 B cell surface antigen, used in pemphigus vulgaris empirically since 2002, with success in 90% of the cases and long periods of remission. Male patient, 33 years old, diagnosed with pemphigus vulgaris, confirmed by histopathology and direct immunofluorescence. He was treated for seven months with numerous treatments, including immunosuppressive drugs, with an unsatisfactory response, until he had complete remission with the use of rituximab. During a 34-month follow-up period, the patient presented a slight clinical relapse, which was successfully controlled with prednisone in a daily dose of 120 mg, soon reduced to 20mg.

Show MeSH
Related in: MedlinePlus