Autoimmune disorders and interleukin-2 therapy: a step toward 'unanswered questions'

We read with interest the case of ''Recurrence of Pemphigus Vulgaris Associated With Interleukin-2 Therapy'' reported by Prussick et al1in a recent issue of theARCHIVES. Indeed, pemphigus vulgaris (PV) and various autoimmune disorders reported during interleukin-2 immunotherapy are diseases in which interleukin-2 might play a key role. Interestingly, these diseases are rare events during interleukin-2 immunotherapy, as discussed by Gaspari in his editorial.2In our own series of 25 patients with metastatic melanoma,3we observed mucocutaneous lesions in 15% of 78 cycles of interleukin-2 infusion. Nine biopsy specimens were studied and did not reveal histologic or direct immunofluorescence patterns of autoimmune bullous skin diseases. Nevertheless, we took a step toward Gaspari's ''unanswered questions'' concerning vitiligo and interleukin-2 therapy. Indeed, we had the opportunity to observe four cases of vitiligo in patients treated with interleukin-2 alone for metastatic melanoma out of our previous series of 25