Abstract: Objective: This article reports a case of severe pemphigus vulgaris with severe osteoporosis treated with rituximab combined with glucocorticoids, providing a reference for the treatment of such patients. Diagnosis and Treatment: The patient was contraindicated for long-term high-dose glucocorticoid therapy due to severe osteoporosis. After systematic evaluation during hospitalization, a personalized treatment regimen was established for intravenous rituximab combined with oral glucocorticoids. Results: After treatment, the oral mucosa and skin lesions were significantly improved, and the glucocorticoid was rapidly reduced while the disease was effectively controlled. Conclusions: For mucosal-predominant pemphigus, particularly in patients with contraindications to long-term glucocorticoid use, the combination therapy of rituximab and glucocorticoids demonstrates favorable efficacy and safety, while enabling rapid tapering of glucocorticoids.

Key words: pemphigus, pemphigus disease area index, rituximab, glucocorticoids, combined therapy