Pregnancy outcome after rituximab treatment before conception in patients affected by severe pemphigus vulgaris/superficialis

Pregnancy is rare among patients affected by pemphigus, especially in European countries, mainly because of older patients, lower fertility rates and possible teratogenic risk. 1 Avoidance of immunosuppressive medications during pregnancy has been recommended, but inadequate treatment of pemphigus may increase morbidity and mortality. 2 Corticosteroids remain the first-line agent for treatment of pemphigus in pregnancy when low dosages are sufficient for disease control; however, prednisone and its metabolites crosses the placenta barrier, and high levels in the serum have been associated with adverse fetal outcomes. 3 IVIg can be useful and safe in treating pregnant patients with PV. 4 B cell depletion therapy, such as rituximab, is widely used in the management of refractory pemphigus, but it is not allowed during pregnancy.5-6 Pregnancy outcome following B cell depletion therapy is almost unknown.