A case of refractory bullous pemphigoid with plasmapheresis-associated thrombopenia: efficacy of pulsed intravenous cyclophosphamide therapy.

We present a 69-year-old woman with refractory bullous pemphigoid successfully treated with pulsed intravenous cyclophosphamide therapy. Because various other early treatments including 4,4'-diaminodiphenylsulphone (DDS), minocycline/nicotinamide, cyclosporin, azathioprine, high-dose oral prednisolone, and methylprednisolone pulse therapy were either ineffective or intolerable, she was treated with double filtration plasmapheresis, but she responded poorly with the rare complication of severe transient thrombopenia. Finally, she gradually recovered with pulsed intravenous cyclophosphamide therapy.