Daclizumab: a novel therapeutic option in severe bullous pemphigoid.

A 52-year-old woman with a body weight of 102 kg presented with widespread multiple blisters and bullae on the whole body before hospitalization. Clinical features and conventional histopathology confirmed the diagnosis of BP; immunohistology and immunoserological tests were performed and were compatible with a diagnosis of BP. The patient was subsequently treated with prednisolone 100 mg/day in combination with azathioprine 100 mg/day, cyclosporin A 200 mg and mycophenolate mofetil 2 g/day. However, disease control was not achieved and the blister formation progressed. During steroid therapy the patient gained 35 kg of body weight and developed diabetes mellitus with glucose levels around 180 mg/dl. Therefore, the dosage of prednisolone was reduced slowly to 5 mg/day, azathioprine was maintained and a bolus intravenous infusion of 100 mg (approximately 1 mg/kg body weight) daclizumab (ZenapaxH) was given fortnightly. Azathioprine treatment with 50 mg/day was continued and steroids were subsequently reduced. In total, the patient received six infusions during hospitalization and as a patient in the day-care centre. The therapy with 5 mg prednisolone, daclizumab and azathioprine was well tolerated and no side effects were observed during or after treatment. Pathological glucose levels normalized and the patient slowly lost body weight. An improvement of the condition of the skin was observed within 2 weeks of treatment with daclizumab. The skin blisters completely resolved and a postinflammatory hyperpigmentation remained as a residual effect. Clinical resolution persisted for approximately 3 months, before new blisters occurred despite the continued treatment with azathioprine and prednisolone. A second series of three daclizumab infusions (100 mg/day) was administered every 3–4 weeks. The patient responded rapidly and has remained free of skin lesions and blisters for more than 10 months so far.