A patient with known pemphigus vulgaris presents acutely with rapidly spreading erosions involving 40% BSA, fever, and dehydration. Serum albumin is 2.1 g/dL. In addition to systemic corticosteroids, which adjuvant therapy is most appropriate to reduce steroid dose and control disease?
- A Rituximab 1000 mg IV two doses 2 weeks apart ✓
- B Dapsone 100 mg/day
- C Azathioprine 2.5 mg/kg/day
- D Cyclophosphamide pulse therapy
Correct answer: A. Rituximab 1000 mg IV two doses 2 weeks apart
Explanation
Rituximab (anti-CD20 monoclonal antibody) is now recommended as a first-line adjuvant in moderate-to-severe pemphigus vulgaris alongside corticosteroids, based on the PEMPHIX trial showing superior response over mycophenolate mofetil. It depletes B cells, dramatically reducing anti-desmoglein antibody production. While azathioprine is a traditional adjuvant, rituximab achieves longer remission and is preferred in severe/refractory disease. Dapsone is not appropriate for pemphigus; cyclophosphamide is reserved for rituximab failure.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.