Facilitated subcutaneous immunoglobulin treatment in pemphigus vulgaris.

A novel administration strategy of immunoglobulin treatment is represented by injection of recombinant human hyaluronidase (rHUPH20) with subcutaneous immunoglobulins. The use of facilitated subcutaneous immunoglobulin treatment (fSCIG) for the treatment of autoimmune conditions is yet to be investigated. We present the case of a 56-year-old female patient with pemphigus vulgaris predominantly of the oral mucous membranes, previously treated for 24 months with azathioprine and medium doses of steroids, with only partial remission. When she came to our attention, a concomitant newly diagnosed infiltrating ductal breast cancer limited the use of immunosuppressive agents. She was started with fSCIG (25 g/monthly). After 18 months of follow-up, her breast cancer has been successfully treated and a substantial decrease of the rate of bullous mucous lesions and improvement of time to lesion healing and resolution was observed. fSCIG might represent a steroid-sparing tool for the treatment of selected cases of pemphigus vulgaris.