Evaluation of Papanicolaou smears in pemphigus vulgaris patients before and after rituximab

Background Pemphigus vulgaris (PV) is a potentially fatal autoimmune mucocutaneous blistering disease. Rituximab (RTX) is a chimeric anti-CD20 monoclonal antibody that is increasingly being used and becoming the first-line therapy in the management of PV. Its impact on cervical cytology and human papillomavirus (HPV) infection risk in this population remains unclear. Objectives To prospectively evaluate cervical Papanicolaou ( Pap) smear results and HPV prevalence before and 6 months after rituximab therapy in women with PV. Methods Twenty-eight women with PV underwent Pap smear and HPV genotyping before and after two rituximab infusions (1 gram, 2 weeks apart) Results The mean age was 55.5 ± 12.1 years; 75% were postmenopausal. After treatment, the proportion of inflammatory smears increased (from 35.7% to 57.1%), though no high-grade lesions appeared ( p  = 0.368). HPV DNA was detected in 25% of patients, predominantly high-risk genotypes. HPV positivity correlated with shorter disease duration (24.0 vs. 84.0 months, p = 0.005) and mucosal PV type (66.7%, p = 0.019). Conclusions Rituximab did not significantly alter Pap smear Bethesda categorization at 6 months, but coincided with increased inflammatory cytology and frequent high-risk HPV. Findings support regular Pap/HPV co-testing and vaccination in women with PV undergoing B-cell depletion therapy.