EARLY DEVELOPMENT OF DISSEMINATED NOCARDIOSIS DURING IMMUNOSUPPRESSIVE TREATMENT FOR PEMPHIGUS VULGARIS

Morrone A., Calcaterra R., Nosotti L., Mussi A., Bonifati C., Franco G., Carducci M.

21° WORLD CONGRESS OF DERMATOLOGY
Buenos Aires, September 30 – October 5 2007

Background
Pemphigus vulgaris is a rare and serious autoimmune disease whose treatment is based on the use of corticosteroids and other immunosuppressive drugs, which can lead after long–term treatment, as an adverse effect, to the development of infectious diseases, particularly in predisposed subjects with previous depression of cell-mediated or humoral immunity.
Method
We analysed the case of pemphigus vulgaris and disseminated nocardiosis afferent to our Hospital
Result
We report a case of pemphigus vulgaris that developed, after only 3 weeks of therapy, a disseminated nocardiosis.
Conclusion
The introduction of the corticosteroids and others immunosuppressive agents reduced the mortality rate of PV from 70% to about 5-15%.
Unfortunately, the infections, favoured by immunosuppression induced by the treatment, represent the main complications and the main cause of death.
In particular, the infections, favoured by the immunosuppression induced by the treatment, constitute the main cause of death. The nocardiosis is a rare acute, sub-acute or chronic infection, caused by many species of bacteria belonging to the genus Nocardia. The infection can manifest itself in cutaneous, pulmonary or disseminated form.
Our patient is the first case who developed a disseminated nocardiosis after a short time treatment (about 3 weeks), at relatively low dosages, in absence of any of the usual risk factors for the development of an infectious disease related to an immunosuppressive treatment.
Therefore, we point out the risk of developing systemic infections, potentially lethal, in patients receiving immunosuppressive therapy, even if for a short time, traditionally used for the treatment of PV and usually well tolerated.
1. Martin FJ, Perez-Bernal AM, Camacho F. Pemphigus vulgaris and disseminated nocardiosis. J Eur Acad Dermatol
Venereol 2000 ; 14 : 416-8.
2. Asilian A, Yoosefi A, Faghihi G. Cutaneous and pulmonary nocardiosis in pemphigus vulgaris: a rare complication of
immunosuppressive therapy. Int J Dermatol 2006 ; 45 : 1204-6.