Plasmapheresis and immunosuppressive therapy. Effect on levels of intercellular antibodies in pemphigus vulgaris.

A patient with pemphigus vulgaris and serious side effects of steroid therapy was treated by exchange plasmapheresis. Eight plasmaphereses were performed over six weeks. Each procedure reduced the serum level of intercellular antibodies by 50% to 87%. A rebound in levels of intercellular antibodies usually followed their depletion but could be minimized or completely suppressed by administration of cyclophosphamide. After six weeks of therapy, clinical symptoms had greatly improved and intercellular antibody levels had decreased from a titer of 5,120 to 160. It is not possible to ascribe these improvements specifically to plasmapheresis since the patient was concurrently receiving low doses of prednisone and intermittent treatment with cyclophosphamide.