Experience with rituximab in patients with pemphigus vulgaris and hepatitis B

Rituximab is an anti-CD20 monoclonal antibody used as first-line therapy for moderate-to-severe pemphigus vulgaris. For many years, it was contraindicated in patients with a past medical history of hepatitis B due to the risk of disease reactivation. However, it has recently been recognized that this infection should be considered a comorbidity requiring monitoring rather than an absolute contraindication. Only a few publications in the dermatologic literature describe in detail the management of rituximab in patients with a history of hepatitis B. We present two cases of pemphigus vulgaris in the setting of resolved hepatitis B infection who received antiviral prophylaxis and rituximab.