To the Editor.—
In the May 1985 Archives, Bahmer etal1 reported successful treatment by continuous-flow-technique plasmapheresis of a 45-year-old man with severe rheumatoid arthritis, who developed a penicillamine-induced pemphigus foliaceus-like dermatosis.The authors stated that "Together with a previously published case report, the mortality rate approaches 10%, taking into account the some 30 cases reported to date." The case report to which they refer2 to support this statement mentions six cases of "bullous cutaneous eruptions with features of pemphigus in patients who were (or had been recently) receiving D-penicillamine (DP) for seropositive rheumatoid arthritis." However, this report does not state that any of these patients died. Hewitt et al2 said that "the evolution of the disease followed two patterns: a benign one, rapidly stopped by moderate doses of corticosteroids, and a classical course, sometimes very difficult to control."Perhaps Bahmer et al intended to refer to a 1978 article by Sparrow,3 who described a 48-year-old man with
Kohn SR. Fatal Penicillamine-Induced Pemphigus Foliaceus-like Dermatosis. Arch Dermatol. 1986;122(1):17. doi:10.1001/archderm.1986.01660130019011
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