Internal Medicine

0521779407-B02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Bullous Pemphigoid 269

thrombocytopenia, liver fibrosis, liver cirrhosis, opportunistic

infection, leukoencephalopathy, pulmonary disease

➣Contraindications

Absolute: pregnancy, nursing mother, alcoholism, alcoholic

liver disease, chronic liver disease, immunodeficiency, blood

dyscrasia, hypersensitivity to methotrexate

Relative: decreased renal function, ascites, pleural

■Rituximab (375 mg/m2 weekly for 4–8 weeks)

➣Side Effects

Infusion reaction

➣Contraindications

Absolute: hypersensitivity to rituximab, hepatitis B carrier,

concomitant cisplatin use

Relative: systemic infection

follow-up

During Treatment

■Chest x-ray and/or skin testing for tuberculosis is recommended at

the onset of systemic therapies.

■Corticosteroids: monitor blood pressure, blood sugar and elec-

trolytes. Baseline bone densitometry and follow-up evaluation

should be performed and calcium and vitamin D along with a bis-

phosphonate is advised for patients on 5 mg/d or higher doses for

>3 months.

■Azathioprine and mycophenolate mofetil: CBC and differential

biweekly×2 months, monthly for third and fourth months. Liver

function studies q month×4 months. CBC and differential and LFTs

q 2–3 months thereafter.

■Cyclophosphamide: CBC with differential, UA for RBCs

■Methotrexate: CBC with differential monthly, BUN/Cr q 1–2 months,

liver enzymes q 1–2 months

Routine

■Monitor for presence of new active blistering

complications and prognosis

■Tends to be chronic, but complete remissions do occur

■Low mortality even without aggressive treatment, except in very

elderly patients