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An event is serious (based on the ICH definition) when the patient outcome is:
* death
* life-threatening
* hospitalisation
* disability
* congenital anomaly
* other medically important event
A 40-year-old woman experienced aggressive course of pemphigus vulgaris during treatment with rituximab for pemphigus vulgaris.
The woman presented with erosions and bullae for 50 days. After further investigations, she was diagnosed with pemphigus vulgaris. Treatment with rituximab was planned. A PCR test for COVID-19 was negative. Her purified protein derivative test (18mm induration) and interferon gamma release assay (IGRA) were positive. She started receiving isoniazid and pyridoxine [vitamin b6]. Thereafter, she was admitted and started receiving rituximab 1g without any systemic steroid as adjuvant [route not stated]. After treatment discontinuation, she was discharged with an advised to stay isolated at home. A few days later, she presented with a rapidly aggressive course of pemphigus vulgaris with the appearance of multiple bullae on her skin and the involvement of nasal mucosa (total activity score: 34), which was consistent with exacerbation of pemphigus vulgaris secondary to rituximab therapy [duration of treatment to reaction onset not stated].
The woman underwent a second PCR test for COVID-19, and meanwhile, she started receiving prednisolone treatment for aggressive course of pemphigus vulgaris. Her PCR test returned positive. Therefore, her treatment for aggressive course of pemphigus vulgaris was changed from prednisolone to immune globulin [IVIG]. Within first 2 days of immune globulin treatment, appearance of new lesions stopped. Her skin lesions started to dry and epithelialize. In a week, her general condition improved, and she was discharged. Few days later, she developed blurred vision, which was diagnosed as ocular herpes and was treated with aciclovir [acyclovir]. At follow-up visit 2 weeks later, a significant amelioration of her symptoms and skin lesion was observed.
Reference
- Ghalamkarpour F, et al. Aggressive course of pemphigus vulgaris following COVID-19 infection. Dermatologic Therapy 33: No. 6, Nov-Dec 2020. Available from: URL: 10.1111/dth.14398 [DOI] [PMC free article] [PubMed]