Pemphigus Vulgaris | Immunobullous Disorders

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Author: Dr Sahibzada Mahmood Noor - Lady Reading Hospital, Peshawar

A 30-year-old male weighing 70 kg presented to Dermatology outpatient with two months history of oral erosions resulting in difficulty in swallowing and vesicobullous lesions involving chest, back, and arms. His biopsy and Direct immunofluorescence confirm the diagnosis of Pemphigus vulgaris.

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Q.1. What is the first line treatment in this patient who can afford the cost ?

Topical clobetasol

Injection Depo mederol

Pulse Intra Venous steroids

Intravenous immunoglobulins

Injection Rituximab

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Q.2. What is the recommended dosage of systemic corticosteroids in this patient ?

1 to 1.5 mg/kg/day

0.5 to 1 mg/kg/day

1.5 to 2 mg/kg/day

2 to 2.5 mg/kg/day

3 to 3.5 mg/kg/day

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Q.3. How many tablets of Deltacortril are equivalent to the recommended dose of Prednisolone in this patient based on his body weight and severity of disease ?

10 tablets daily

12 tablets daily

14 tablets daily

16 tablets daily

18 tablets daily

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Q.4. The patient is admitted to indoor, and he has difficulty in swallowing the tablets equivalent to the recommended dosage of Prednisolone. What dosage of Injection Dexamethasone (Decadron) need to administered equivalent to recommended dosage of oral prednisolone ?

1 cc daily

2 cc daily

2.5 cc daily

4 cc daily

5 cc daily

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Q.5. After one month of treatment with Oral Prednisolone on the recommended dosage, fresh lesions still appear. The patient cannot afford Rituximab, what strategy can be adopted to control the disease with Oral prednisolone ?

Increase the dosage from 1.5 to 2 mg/kg/day

Increase the dosage from 1.5 to 3 mg/kg/day

Increase the dosage from 1.5 to 4 mg/kg/day

Increase the dosage from 1.5 to 3.5 mg/kg/day

Increase the dosage from 1.5 to 4 mg/kg/day

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