Childhood ocular mucous membrane pemphigoid successfully treated with rituximab

Ocular mucous membrane pemphigoid (MMP) is a chronic autoimmune blistering disease that usually affects elderly patients being extremely rare in pediatric population. Despite aggressive immunosuppressive therapy, ocular MMP may progress causing significant morbidity. Herein, we describe a toddler with ocular MMP successfully treated with rituximab.     

环孢素治疗银屑病并发天疱疮一例

银屑病并发天疱疮临床少见,两种疾病治疗存在矛盾。该例患者有银屑病病史7年,20 d前出现水疱、糜烂;皮损组织病理及疱病自身抗体检查支持寻常性银屑病并发寻常性天疱疮诊断,给予口服环孢素及外用药物治疗后病情改善。     

Refractory pemphigus vulgaris treated with rituximab and mycophenolate mofetil

The main treatment for pemphigus vulgaris are systemic corticosteroids andimmunosuppressive agents, but due to adverse reactions and therapeutic failure, newdrugs such as rituximab and mycophenolate mofetil have been used. In this case reportare described two cases of severe pemphigus vulgaris refractory to varioustreatments, with resolution after use of rituximab and mycophenolate mofetil,associated with corticosteroids. A higher-than-usual dose of rituximab was employed,without the occurrence of serious adverse reactions. Mycophenolate mofetil was addedas adjunctive therapy due to lack of response to azathioprine.     

Treatment of severe refractory pemphigus vulgaris with rituximab

Pemphigus vulgaris is a potentially fatal autoimmune bullous disease. High doses of immunosuppressive drugs are used in managing severe cases of pemphigus. Rituximab, an anti-CD20 monoclonal antibody, has proven to be effective in patients with refractory pemphigus vulgaris and pemphigus foliaceus. We review cases of pemphigus vulgaris and pemphigus foliaceus not associated with lymphoma that were treated with rituximab, and we report a new case of severe refractory pemphigus vulgaris successfully treated with rituximab.     

Childhood pemphigus treated with gold.

A case of childhood pemphigus is reported. The natural history of this rare entity and past methods of treatment are reviewed. We also report on what is to our knowledge the first known use of gold in the treatment of childhood pemphigus. This modality appears to have been of benefit in our patient to date.     

联合rituximab治疗一例寻常型天疱疮的疗效观察

目的 观察联合抗CD20单克隆抗体rituximab治疗寻常型天疱疮的临床疗效,探讨其作用机制.方法 寻常型天疱疮患者1例,口腔黏膜顽固性痛性糜烂和溃疡,甲泼尼龙80 mg/d,疗效欠佳.改用rituximab治疗,每周1次静脉注射500 mg,连续3周,第4周使用大剂量静脉滴注丙种球蛋白400 mg·kg-1·d-1,共5天.第2个月重复此疗程,共2个疗程.同时甲泼尼龙渐减.评价治疗前后临床症状和相关实验室指标,并用ELISA检测血清中抗Dsg3抗体滴度,ISG1、ISG4亚型水平及IFN-γ、IL-4和IL-10细胞因子水平.结果 该患者于停药3个月后症状明显好转,皮损消退无复发,抗Dsg3抗体滴度显著下降,变化趋势与临床症状一致.特异性抗体IgG4亚型在用药初期保持高水平,停药3个月后开始下降.血清IFN-γ、IL-10水平亦和疾病严重度有关.结论 联合rituximab治疗寻常型天疱疮有效,其机制可能通过消除其特异性抗体,尤其是IgG4亚型抗体发挥效应.     

Psoriasis vulgaris treated successfully with mycophenolate mofetil

Mycophenolate mofetil (MMF) is a new immunosuppressive drug which non-competitively and reversibly blocks the de novo synthesis of guanine nucleotides required for DNA and RNA synthesis during T- and B-cell proliferation. This induces a selective inhibition of lymphocyte proliferation. Thus MMF is currently used to prolong graft survival in renal transplant patients. In this communication we describe the first case of a man with severe psoriasis treated successfully with oral MMF without short-term side-effects. The psoriasis area and severity index score decreased during therapy (5 weeks) from 22.0 to 11.4. Thus MMF appears to be an effective therapeutic alternative in the treatment of severe psoriasis.     

Nocardiosis in a patient with pemphigus foliaceus treated with rituximab

Rituximab is a chimeric human/murine monoclonal anti‐CD20 antibody. This agent is an effective therapeutic option in severe types of pemphigus. However, rituximab may cause opportunistic infections if used in immunosuppressed patients. We reported a case of diffuse Nocardia infection following rituximab treatment in pemphigus foliaceus. Rheumatoid arthritis protocol applied in our patient. Rituximab was used at a dose of 1000 mg every 2 weeks. Because the disease was not adequately controlled, rituximab treatment was administered six times every 15 days. One week after the sixth dose of the rituximab, she presented lassitude and multiple palpable masses in soft tissue of the upper extremity. Thereafter, the aspirate culture of the abscess on the left shoulder was taken and confirmed to be disseminated nocardiosis. She was treated with linezolid and meropenem for 1 month; however, amikacin was added because the patient did not respond adequately to linezolid and meropenem therapy. The patient died of cardiac arrest because of her comorbidities. In this case, prolonged administration of rituximab therapy may have caused the development of nocardiosis. Therefore, all patients should have a sensible balance of risk and benefit, considering the use of rituximab.