Fatal Penicillamine-Induced Pemphigus Foliaceus-like Dermatosis

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