A case of penicillaminc-induced pemphigus, successfully treated by plasma exchange

Penicillamine, used for the treatment of rheumatoid arthritis, is known to induce severe side-effects on the skin resembling lupus en thematosus, epidermulysis bullosa, pseudoxanthoma elasticuni, elasiosis perforans serpinginosa and pemphigus-like dermatosis, which usually occur alter long-term therapy, Although rare, the pemphigus-like dermatosis is not always self-limiting and may persist for months after discontinuation of the drug. We report a patient who developed a pemphigus-like dermatosis after a year of treatment with penicillamine for severe seropositive rheumatoid arthritis. Despite daily therapy with 40 mg of prednisolone and 100 mg of azathioprine, skin lesions continued to appear for 18 months after discontinuation of penicillamine. Four plasma exchanges over a period of 2 weeks achieved healing of the lesions and resulted in the disappearance of pemphigus intercellular antibody from the serum. To our knowledge, only one case of penicillamine-induced pemphigus successfully treated with plasma exchange has been reported, though there exist reports of plasma exchange^1,2 used in the treatment of pemphigus vulgaris.