New onset psoriasis after rituximab for treatment of idiopathic membranous nephropathy

摘要

A 51 -year-old man with good past health presented with nephrotic syndrome in April 2003, due to idiopathic membranous nephropathy (IMN). He was treated with predniso-lone 45 mg daily and mycofenolate mofetil 1000 mg twice daily. However, he developed steroid-induced psychosis, requiring a rapid taper of prednisolone. He achieved partial remission and both medications were tailed off in 6 months. He had a relapse one month later. He was treated with cyclosporin A (CYC) alone and achieved complete remission. He had a second relapse 2 years later, to which he responded to an increased dose of CYC. Four years later, he had a third relapse. He was put on Rituximab 375 mg/m2 per week for 4 weeks. After 3 months, while CYC was tapered to 25 mg twice daily, he developed an erythematous papulopustular eruption over his trunk and limbs with silvery scaling, clinically compatible with pustular psoriasis (Fig. 1)