Sirolimus for acute pemphigus vulgaris: A case report and discussion of dualistic action providing for both immunosuppression and keratinocyte protection

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Sirolimus for acute pemphigus vulgaris: A case report and discussion of dualistic action providing for both immunosuppression and keratinocyte protection Sergei A. Grando, MD, PhD, DSc, Vivian T. Laquer, MD, Hai M. Le, MD Journal of the American Academy of Dermatology Volume 65, Issue 3, Pages 684-686 (September 2011) DOI: 10.1016/j.jaad.2011.01.029 Copyright © 2011 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Enzyme-linked immunosorbent assay (ELISA) results of desmoglein (Dsg) 1 and 3 serum levels at different time points. 1 = Before treatment (November 2008). 2 = During treatment with low, 40 mg/d, dose of prednisone (January 2009). 3 = 3 weeks after starting combined therapy with 80 mg/d of prednisone plus azathioprine, tetracycline, niacinamide, and intravenous immunoglobulin (February 2009). 4 = Clinical remission during prednisone tapering (June 2009). 5 = After appearance of new pemphigus vulgaris (PV) lesion while on 10 mg/d of prednisone (September 2009). 6 = Nonhealing PV lesion while at 40 mg/d of prednisone (November 2009). 7 = When starting sirolimus (February 2010). 8 = In clinical remission (May 2010). Cut-off value for Dsg 1 was 14 U and for Dsg 3 was 9 U. Journal of the American Academy of Dermatology 2011 65, 684-686DOI: (10.1016/j.jaad.2011.01.029) Copyright © 2011 American Academy of Dermatology, Inc. Terms and Conditions