Successful treatment of recalcitrant oral pemphigus vulgaris with mycophenolate mofetil

Oral pemphigus vulgaris (OPV) is an intraepithelial autoimmune bullous disease with circulating autoantibodies against desmoglein 3. The disease is difficult to treat and in some cases may be fatal. Mycophenolate mofetil (MMF), a new immunosuppressive drug which selectively inhibits cytotoxic lymphocytes and antibody production by B-lymphocytes was originally used to treat acute graft rejections in renal transplanted patients. The objective of this trial was to assess the therapeutic efficacy of MMF on OPV. One 61 year-old male patient with oral pemphigus confirmed via histopathology, direct and indirect immunoflourescence, was treated with MMF. After the confirmation of the diagnosis, MMF was administered orally in a dose of 2 g daily. Routine laboratory studies and other recommended laboratory tests for MMF were performed at regular intervals. The patient responded very well to the therapy and all lesions healed completely within 4 months. Under a maintenance therapy of 200 mg MMF per day no relapse of the disease occurred for a follow-up period of 3 years. No side-effects were observed. MMF is a safe and effective therapy for oral OPV. More clinical double-blind studies should be performed to confirm our result