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January 1990

Immunosuppressive Therapy of Pemphigus Vulgaris Complicated by Nocardia PneumoniaGold as an Alternate Therapy

Author Affiliations

The Pennsylvania State University College of Medicine, Hershey

Arch Dermatol. 1990;126(1):27-28. doi:10.1001/archderm.1990.01670250031003

REPORT OF A CASE  In 1985, a previously healthy 50-year-old woman developed oral blisters followed by blisters on her trunk and scalp, and presented to her local dermatologist. Results of a biopsy specimen confirmed the diagnosis of pemphigus vulgaris, and treatment with prednisone and dapsone was begun. This treatment failed to control the disease adequately, and she was referred to The Milton S. Hershey Medical Center, Hershey, Pa, in November 1986.The diagnosis was confirmed, and indirect immunofluorescence revealed pemphigus antibodies at a titer of 1:320 on both monkey and guinea pig esophagus. She was given prednisone and azathioprine (Imuran) with doses up to 80 and 150 mg a day, respectively. Her course over the next 10 months was complicated by flares of the pemphigus whenever the prednisone dosage was tapered below 20 to 30 mg/d, and by staphylococcal skin infections requiring treatment with oral antibiotics on multiple occasions.In

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