Atypical Bullous Pemphigoid After Linagliptin Intake

Abstract

Patient: Female, 77-year-old Final Diagnosis: Atypical bullous pemphigoid Symptoms: Bullous skin lesions Medication: — Clinical Procedure: — Specialty: Dermatology Objective: Unusual clinical course Background: Bullous pemphigoid is a common pruritic skin lesion reported in elderly patients. It is caused by an immuno-logic reaction between autoantibodies and hemidesmosome proteins of epithelial cells. The disease is characterized by a symmetrical blister distribution on the body. Diagnosis should be suspected in elderly patients presenting with a tense blister on normal-appearing skin or on an erythematous base. In the literature, several forms of typical bullous pemphigoid after treatment with linagliptin have been reported. However, this is the first reported case of atypical nonbullous pemphigoid after linagliptin intake. Case Report: A 77-year-old woman presented with multiple erythematous papules and nodules on the upper extremities and trunk. The patient was being treated with linagliptin for diabetes. Diagnosis was made with biopsy and histopathological studies, followed by direct immunofluorescence. The histopathological study showed a subepidermal blister with an underlying polymorphous infiltrate, mainly of an eosinophilic profile. Direct immunofluorescence showed linear IgG and C3 antibodies to hemidesmosomes at the lamina lucida of the basement membrane. Thus, the diagnosis of atypical nonbullous pemphigoid was made. Conclusions: This report emphasizes the great variety of bullous pemphigoid presentation and the need for a greater level of awareness of the adverse effects of linagliptin. Thus, atypical nonbullous pemphigoid should be considered among the potential differential diagnoses in patients with multiple erythematous papules and nodules on the upper extremities and trunk.

Bullous Pemphigoid in Older Adults Treated with DPP4i: A Case Series

“…The first cases of BP associated with DPP4is were reported in 2011, since then evidence supporting their association has increased [3,4,14,15,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. Although the pathophysiology is not fully yet understood, it is hypothesized that DPP4 is modify the immune response and/or alter the antigenic properties of the epidermal basement membrane resulting in bullous pemphigoid [43].…”