A patient with biopsy-proven pemphigus vulgaris presents with severe disease involving 45% BSA. Serum anti-desmoglein 3 antibody titre is markedly elevated. Which first-line intravenous therapy is indicated for rapid control when systemic corticosteroids alone are insufficient?

• A Intravenous rituximab 1 g two doses 2 weeks apart
• B Intravenous methylprednisolone pulse 1 g/day for 3 days
• C Intravenous cyclosporine 5 mg/kg/day
• D Intravenous immunoglobulin (IVIG) 2 g/kg per cycle ✓

Explanation

IVIG at 2 g/kg per cycle divided over 3-5 days is a well-established therapy for acute severe pemphigus when corticosteroids alone are insufficient. It works by Fc receptor blockade and accelerated catabolism of pathogenic antibodies. It acts rapidly within days. Methylprednisolone pulse is used but carries significant infection risk in open erosions. Rituximab is increasingly used but is not the acute bridging therapy of choice. IVIG provides rapid, temporary control while waiting for rituximab or other steroid-sparing agents to take effect.

Reference: Bolognia's Dermatology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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