Plasmapheresis for Facilitating Readministration of Rituximab After Paradoxical Exacerbation in Pemphigus Vulgaris: A Case Report

Rare reports of post-rituximab exacerbation of pemphigus vulgaris (PV) have been published, with some therapeutic protocols proposed for managing this condition. A 40-year-old female with PV experienced an exacerbation of mucocutaneous lesions following rituximab administration. She failed to respond to conventional immunosuppressive agents, intravenous immunoglobulin, and ocrelizumab, so plasmapheresis was administered. Then, further doses of rituximab were prescribed, and mucocutaneous lesions improved significantly. We propose plasmapheresis as a possible treatment for post-rituximab PV exacerbation, also noting that subsequent doses of rituximab can be safe and effective.