Rituximab Treatment for Paraneoplastic Pemphigus Associated with Follicular B-Cell Lymphoma: A Case Report and Review of Treatment Outcome

Waranaree Winayanuwattikun, Leena Chularojanamontri, Papapit Tuchinda, Penvadee Pattanaprichakul, Kanokvalai Kulthanan


Objective: To report a case of paraneoplastic pemphigus (PNP), a rare disease, associated with follicular B-cell lymphoma. Treatment outcomes of PNP associated with follicular B-cell lymphoma following rituximab treatment were also reviewed in this article.
Case presentation: We reported a PNP patient presenting with intractable stomatitis and erythema multiforme-like lesions. Skin biopsy from erythema multiforme-liked lesion revealed interface dermatitis and necrotic keratinocytes. Direct immunofluorescence demonstrated immunoglobulin G deposition at intercellular space, as well as complement deposition at dermo-epidermal junction. Indirect immunofluorescence using rat bladder substrate was helpful in confirming the diagnosis of PNP. Further investigations revealed an underlying disease of follicular B-cell lymphoma. He was treated with rituximab and systemic corticosteroids. Improvement of mucocutaneous lesions and lymphoma were noted. Nevertheless, he developed hospital-acquired pneumonia and died from septic shock shortly after
receiving conventional chemotherapy. His survival duration was approximately 8 months after diagnosis of PNP. 
Conclusion: It seemed that rituximab might provide promising benefits for mucocutaneous lesions in PNP patients associated with follicular B-cell lymphoma.


Paraneoplastic pemphigus; rituximab; follicular B-cell lymphoma; therapy; bronchiolitis obliterans

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