Pemphigus in a patient treated with penicillamine for generalized morphea

Abstract

A 56-year-old woman with generalized morphea was treated with penicillamine. Four months after commencing treatment, she developed an eruption clinically, histologically, and immunopathologically consistent with pemphigus. The eruption disappeared following withdrawal of the drug. It is suggested that penicillamine initiated epidermal damage.

Three cases of bullous morphea: histopathologic findings with implications regarding pathogenesis

“…Other reports have proposed eosinophils as a crucial feature in the development of bullae in cases of scleroderma, and in others, bullous morphea developed 3 years after local radiation therapy . Still in others, the suggested cause is an autoimmune disease superimposed to the morphea, such as in cases of epidermolysis bullosa, pemphigus foliaceous or pemphigus vulgaris induced by penicillamine …”

Decline of anti-desmoglein 1 IgG ELISA scores by withdrawal of d-penicillamine in drug-induced pemphigus foliaceus

“…The major subtypes of pemphigus include pemphigus vulgaris, pemphigus foliaceus (PF) and paraneoplastic pemphigus. Both pemphigus vulgaris and PF may be induced by drugs and many drugs have been suspected as pemphigus‐inducing agents 4–7 …”

“…Sulfhydryl group drugs are well known to cause drug‐induced pemphigus (DIP) and there is an outstanding number of cases induced by d ‐penicillamine, implying a role in inducing autoimmune disease 6–8 . Accumulation of case reports seems to have elucidated two forms of DIP 7 .…”