Rituximab and IVIG for the treatment of bullous pemphigoid: critical analysis of the current literature

Background
Bullous Pemphigoid (BP) is the most common subepidermal autoimmune blistering disease. We want to present a case with resistant bullous pemphigoid accompained by telling both clinical features and treatments.

Case summary
A 67 year-old female with diabetes mellitus applied to dermatology outpatient clinic because of pruritus. Our patient didn’t receive complete clinical response with the treatments of methylprednisolone aceponate lotion, bilastine tablet, omalizumab, oral steroid, azathioprine and tetracycline. In addition, she became insulin dependent diabetes mellitus because of oral steroid and azathioprine raised the levels of her liver enzymes. We had to stop these treatments. Now our patient is in remission with the treatments of rituximab and IVIG.
Conclusion
We used rituximab and IVIG which are combined last step treatment regimens for our case and achieved to treat her. We think that our case report will contribute to literature because such difficult, rare cases may appear to clinicians at any time and our case may be a guide for clinicians.