Considerations on Immunization and Immunosuppression of Patients With Autoimmune Blistering Diseases During COVID-19 Pandemic in Brazil: Case Report

Abstract

Autoimmune blistering diseases comprise a rare group of potentially life-threatening dermatoses. Management of autoimmune disorders poses a challenge in terms of achieving disease control and preventing adverse events. Treatment often requires an individualized approach considering disease severity, age, comorbidities, and infectious risk especially in the context of the ongoing COVID-19 pandemic. Knowledge regarding SARS-CoV-2 infection is still evolving and no specific antiviral therapy is available yet. We report four patients with active disease that required adjustment of treatment during the pandemic to discuss the use of immunosuppressants and immunobiologics, weighing potential risks and benefits of each therapy modality and vaccination status.

Keywords: COVID-19; SARS-CoV-2; autoimmune blistering diseases; immunosuppressants; pemphigus; rituximab; vaccine.

Figure 1

A 36-year-old man with pemphigus vulgaris. (A) Confluent erosions with purulent crusts on the scalp in February 2021. (B) Improvement of the lesions 9 months after rituximab treatment.

Figure 2

A 61-year-old man with pemphigus vulgaris had a recurrence of the disease after withdrawn of mycophenolate mofetil in November 2021 and presented (A) eroded plaques with purulent crusts and keratotic areas on the trunk in July 2021. Lesions were recalcitrant to prednisone 1 mg/kg/d and mycophenolate mofetil 3 g/d, and only improved 1 month after 2 rituximab infusions (B).