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Pemphigus Vulgaris — SCE Dermatology MCQ

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HardBlistering DiseasesPemphigus VulgarisSCE Dermatology

A 50-year-old man is being treated for pemphigus vulgaris with Rituximab. Before starting treatment, which vaccination-related consideration is most important?

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Correct answer: B — Update pneumococcal and influenza vaccination and check hepatitis B status

Before starting Rituximab (anti-CD20), patients should have their vaccination status reviewed and updated. Live vaccines should be given at least 4 weeks before treatment (and avoided during and for 6-12 months after). Non-live vaccines (pneumococcal, influenza, COVID-19) should be administered. Hepatitis B screening is mandatory as Rituximab can cause fatal hepatitis B reactivation; HBsAg-positive patients require antiviral prophylaxis. Rituximab causes prolonged B-cell depletion (6-12 months), rendering vaccinations less effective during this period.

Reference: BAD 2017 Pemphigus Guidelines; BSR/BHPR Rituximab Guidelines