Rituximab in Severe Mucocutaneous Pemphigus Vulgaris Complicated by Sepsis: a Difficult Path to Disease Control

Introduction: Pemphigus vulgaris is an autoimmune blistering disease treated with glucocorticosteroids and immunosuppressive agents.Rituximab, an anti-CD20 monoclonal antibody, is currently one of the main recommended therapies; however, its use may be limited by multiple contraindications, including severe infections and other complications associated with underlying disease.Objective: To present a case of severe mucocutaneous pemphigus vulgaris complicated by sepsis and pulmonary embolism, in which effective rituximab treatment was possible only after initial stabilization and bridging therapy.Case report: A 65-year-old patient with severe pemphigus vulgaris was admitted to the dermatology department.The disease was resistant to glucocorticosteroids, azathioprine, and methotrexate.The clinical course was further complicated by sepsis and bilateral pulmonary embolism, requiring management in the intensive care unit.After stabilization, two rituximab infusions were administered, resulting in remission of most skin lesions.Conclusions: This case highlights that although rituximab is one of the most effective therapies for pemphigus vulgaris, its safe administration may require prior control of severe disease-related complications and carefully planned bridging treatment.