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A patient with severe rheumatoid arthritis received d-penicillamine treatment for 16 months. She developed mild pruritus 6 months after d-penicillamine initiation, and severe pemphigus 10 months after d-penicillamine was changed to azathioprine. Subsequent methylprednisolone pulse therapy resulted in a transient clinical remission of pemphigus. A literature review of d-penicillamine induced pemphigus and high dose methylprednisolone pulse therapy is presented.
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