[A fatal case of pemphigus vulgaris with interstitial pneumonia occurring during gold therapy].

We report a case of a 52-year-old female with therapy-resistant pemphigus vulgaris. She was treated with prednisone, azathioprine and gold sodium thiomalate. After administration of a total dose of 110 mg gold sodium thiomalate, she suddenly developed pityriasis rose-like drug eruptions and interstitial pneumonia and died despite intensive care including pulse therapy. In Japan, there have been 8 reported cases of pemphigus or bullous pemphigoid that developed interstitial pneumonia during gold therapy. In these 7 cases, interstitial pneumonia occurred after administration of 110 to 430 mg gold sodium thiomalate, and 4 cases died. This rate of death is higher than those with other diseases: i.e., 9 dead cases among 99 cases of interstitial pneumonia developing in patients with rheumatoid arthritis or asthma under treatment with gold sodium thiomalate. We think that it is necessary to reevaluate the combined treatment of sodium thiomalate and other immunosuppressive drugs such as azathioprine in pemphigus, because we also found 2 other fatal cases among the 4 reported ones with interstitial pneumonia.