INTRODUCTION: Rituximab is a chimeric human-mouse monoclonal antibody,which binds to the CD20 antigen on B and pre-B lymphocytesand causes depletion of CD20+ cells in the mechanism of complement-dependent and independent cytolysis, antibody-dependent cell cytotoxicityand the mechanism of apoptosis. Rituximab is currently registeredfor the treatment of non-Hodgkin's lymphoma, chronic lymphocyticleukaemia and rheumatoid arthritis. Rituximab has alsodemonstrated efficacy in a number of other autoimmune diseases, includingsystemic lupus erythematosus and Sjögren's syndrome. In severeor recalcitrant cases of pemphigus vulgaris and pemphigus foliaceus,rituximab was applied as an adjuvant drug.

OBJECTIVE: To present the efficacy of rituximab monotherapy inpatients with pemphigus foliaceus, who had contraindications to classicimmunosuppression, and a review of the literature.

CASE REPORTS: We present 2 patients with pemphigus foliaceus, a 66-year old male and a 61-year old female, treated with rituximab inmonotherapy as a first-line treatment. In the first patient serologicalnegativisation and improvement were observed 4 months after therapyinitiation. After 8 months further, significant clinical improvement,with sparse residual lesions, was observed. In the second case similarresults were achieved.

CONCLUSIONS: In patients with pemphigus foliaceus significant improvementwas observed after rituximab monotherapy. Serological negativisationwas achieved prior to clinical remission. This unusual phenomenonmay be explained by rapid depletion of CD20+ cells andinhibition of antibody production, while in vivo bound pathogenicpemphigus antibodies remained active.