Low-dose aurothioglucose in pemphigus vulgaris

Three female Jewish patients with typical pemphigus vulgaris involving the skin and the oral mucosa were managed with weekly i.m. aurothioglucose injections less than or equal to 25 mg. After obtaining a remission, the interval between injections was gradually lengthened. Fluocortolone was given in the first few weeks in decreasing dosages, starting with 60 mg/day. The two younger patients, aged 50 and 39, were in complete remission on follow-up 42 and 27 months later, respectively. They currently receive 25 mg of aurothioglucose every 6 to 8 weeks. One had had transient parotitis while on therapy. The other had had benign familial leukopenia, prior to the institution of gold therapy, and her total leukocyte and differential counts remained constant. The third patient, aged 80, who had widespread and deteriorating pemphigus, was switched to a steroid-azathioprine regimen because gold did not improve her condition quickly enough. Thus, some pemphigus patients may experience prolonged clinical remissions and improved quality of life on low doses of gold.