[Treatment of pemphigus vulgaris with high-dose intravenous immunoglobulins in a patient with steroid-induced osteonecrosis of the femoral head].

High-dose immunoglobulins (IVIG) are important agents in the treatment of numerous autoimmune disorders. In the field of dermatology, increasing numbers of patients with bullous autoimmune disorders and mixed connective tissue diseases have been treated. We successfully treated a patient with pemphigus vulgaris with IVIG, after he had developed osteonecrosis of his right femoral head while on azathioprine and corticosteroids. After reduction of oral corticosteroids, his disease flared dramatically. The addition of a high dose immunosuppressive regimen including azathioprine and dapsone failed to help. Thus high dose IVIG (2 mg/kg, 4 weeks interval) therapy was initiated and induced complete healing of the skin lesions. The clinical improvement and the titer of the relevant autoantibodies against desmoglein 3 and desmoglein 1 showed correlation.