Drug-induced Linear IgA Bullous Dermatosis: A Case Report and Review of the Literature

Abstract

Linear IgA bullous dermatosis (LABD) is a rare blistering autoimmune disease. Although most cases are idiopathic, numerous drugs have been identified as capable of eliciting LABD. This paper provides an overview of the pathogenesis, diagnosis and treatment of drug-induced LABD, together with a report of a representative case of vancomycin-induced LABD. In addition, the results of a comprehensive literature review are reported to provide an overview of putative culprit drugs and their frequency, in order to enable clinicians to diagnose patients with putative adverse drug reactions presenting with blistering. Linear IgA bullous dermatosis (LABD) is a rare subepidermal autoimmune blistering disease characterized by linear deposition of IgA along the basement membrane zone. Although most reported cases are idiopathic, there is a subset of patients with drug-induced LABD. Various drugs have been associated with the drug-induced form of the disease. This paper reviews the literature on drugs reported to elicit linear IgA dermatosis and its specific clinical presentation. In addition, a case report of a 77-year-old male patient with linear IgA dermatosis induced by vancomycin is described. The aim of this paper is to emphasize the need to include this differential diagnosis in cases of suspected adverse drug reactions, as well as to highlight the role of drugs in LABD.

Linear IgA bullous dermatosis: A rare manifestation of amoxicillin‐clavulanic acid treatment

“…2 Furthermore, some authors suggest that other clinical conditions such as infections and autoimmune diseases may also play a role in LABD pathogenesis. 3 Our patient had a history of type 1 diabetes mellitus and was treated for an upper respiratory tract infection. Thus, proving the exclusive role of the amoxicillin-clavulanic acid may be challenging.…”

“…1 Vancomycin is the most common drug involved, accounting for nearly 50% of cases. 2,3 Other common antibiotics and nonantibiotic drugs have been linked to LABD. 4 Amoxicillin-clavulanate is one of the most widely used antibiotics and, because of its prevalent use, several common dermatologic side effects have been well described, such as type I hypersensitivity reactions, serum sickness-like reaction, symmetrical drug-related intertriginous and flexural exanthema, generalized exanthematous pustulosis, drug reaction with eosinophilia and systemic symptoms, Steven-Johnson syndrome and toxic epidermal necrolysis.…”

Vancomycin-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Masquerading as Elusive Sepsis

“…Dermatological hypersensitivity reactions may range from a simple skin rash to Linear IgA Bullous Dermatosis (LABD), in which IgA autoantibody formation can be triggered by vancomycin [12]. Other dermatologic conditions include exfoliative dermatitis, leukocytoclastic vasculitis, SJS, and TEN.…”

Vancomycin-induced linear Immunoglobulin A bullous dermatosis

“…Reports of disease incidence range from less than 0.5 to 2.3 cases per million individuals per year 1. Aetiology of LABD can be drug-induced; autoimmune, such as ulcerative colitis; infectious (upper respiratory tract, gynaecological infections, typhoid, brucellosis, varicella zoster and tetanus); malignant; or idiopathic 2. Drug-induced LABD cases represent approximately 37.5% of all LABD in adults.…”

“…Linear IgA deposition at the dermal–epidermal junction of the basement membrane zone is pathognomonic of LABD. Drug-induced LABD typically resolves with withdrawal of the offending agent 2. In severe or persistent cases, treatments including dapsone, sulfonamides, colchicine, topical and oral corticosteroids or intravenous immunoglobulins have been effective, although limited data are available.…”