Báo cáo trường hợp bệnh: Điều trị rituximab trên bệnh nhân pemphigus vulgaris kháng trị=Case report: Rituximab treatment in a patient with refractory pemphigus vulgaris

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Tác giả: Lan Anh Nguyễn, Thị Phương Nhung Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y dược lâm sàng 108, 2024

Mô tả vật lý: tr.105-109

Bộ sưu tập: Metadata

ID: 244947

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Pemphigus vulgaris is a group of autoimmune diseases, caused by autoantibodies against the interspinous bridge, causing acanthosis in the epidermis, that creating painful shallow, easily ruptured blisters, crusting, and may be accompanied by mucosal damage. Rituximab is a chimeric monoclonal anti-CD20 antibody that reduces the number of B lymphocytes, downregulates autoantibody producing, this is the first biologic drug licensed for pemphigus treatment. The drug is well tolerated and has amazing treatment effects, especially in patients with treatment - resistant pemphigus vulgaris. A case report: A female patient who was diagnosed with pemphigus vulgaris who underwent many hospitalizations for treatment in 2 years with systemic corticosteroids and immunosuppressive drugs but the disease responded poorly, and experienced many side effects of the medication. The patient was prescribed rituximab at a dosage of 1 gram at weeks 0 and 2. Clinical images were recorded at the time before treatment, after 1 month and 3 months, showing that the patient achieve complete remission. Conclusion: Rituximab is considered a promising new management of pemphigus in general and pemphigus vulgaris in particular. This drug is well tolerated and achieves rapid clinical response.Pemphigus vulgaris là một bệnh lý tự miễn, do tự kháng thể kháng lại cầu nối liên gai gây hiện tượng ly gai ở thượng bì, tạo các bọng nước nông, vảy tiết, có thể kèm theo tổn thương niêm mạc gây đau đớn cho bệnh nhân. Rituximab là một loại kháng thể đơn dòng thể khảm kháng CD20, qua đó làm giảm số lượng tế bào lympho B, dẫn đến giảm sản xuất kháng thể, là thuốc sinh học đầu tiên được cấp phép cho điều trị pemphigus, thuốc dung nạp tốt và cho hiệu quả điều trị tối ưu, đặc biệt ở những bệnh nhân pemphigus vulgaris kháng trị. Báo cáo trường hợp lâm sàng: Bệnh nhân nữ đã được chẩn đoán xác định pemphigus vulgaris, đã trải qua nhiều đợt nhập viện điều trị trong 2 năm với corticosteroid đường toàn thân và các thuốc ức chế miễn dịch nhưng bệnh đáp ứng kém, và gặp nhiều tác dụng phụ của thuốc. Bệnh nhân đã được điều trị rituximab liều 1 gam vào tuần 0 và tuần 2. Hình ảnh lâm sàng được ghi nhận ở các thời điểm trước điều trị, sau 1 tháng và sau 3 tháng, cho thấy bệnh nhân đạt lui bệnh hoàn toàn. Kết luận: Rituximab được xem là hướng đi mới đầy hứa hẹn trong điều trị pemphigus vulgaris. Thuốc dung nạp tốt, đạt được đáp ứng lâm sàng nhanh chóng.

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