SHM Converge Scientific Abstract ePoster Gallery-Bullous Pemphigoid Another Reason Not to Avoid Dipeptidyl-Peptidase 4 Inhibitors

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This case report describes likely drug-induced bullous pemphigoid (BP) in an 80-year-old woman with type 2 diabetes and multiple comorbidities who developed a month-long diffuse blistering rash that spread from the legs to the trunk, arms, palms, and soles. The blisters ruptured and healed without scarring. An outpatient dermatologist stopped several diabetes medications, including linagliptin and dulaglutide, before admission.<br /><br />During hospitalization, she was treated for secondary infection and underwent skin biopsies. Histology showed features consistent with the urticarial phase of BP, and direct immunofluorescence demonstrated linear IgG and C3 deposits along the dermal-epidermal junction. Serology supported the diagnosis with elevated BP180 and BP230 antibodies. She was started on prednisone and doxycycline, with niacinamide added at discharge. While initially stable, her rash recurred when prednisone was tapered, and doxycycline later caused esophagitis, prompting a change in therapy to dapsone, continued niacinamide, topical betamethasone, and prednisone.<br /><br />The discussion reviews BP as an autoimmune blistering disease caused by antibodies against hemidesmosomal proteins BP180 and BP230, often triggered by medications. DPP-4 inhibitors (“gliptins”) are highlighted as important culprits, though GLP-1 agonists have also been implicated in rare reports. Because latency from drug exposure to disease onset may be long, identifying the exact trigger can be difficult, but the authors believe linagliptin was the most likely inciting agent in this patient.<br /><br />The authors emphasize that early recognition, discontinuation of the offending drug, and prompt treatment are essential to reduce morbidity and mortality.

Asset Subtitle

Pranay Bonagiri

Meta Tag

Author List Anjalee Raman, Pranay Bonagiri, Sharjeel Hassan, William Burrows

Category Clinical Vignettes

Concept Bullous Pemphigoid

Concept Medication Trigger

Concept Histology

Concept Direct Immunofluorescence

Concept BP180

Distinguished Non-Finalist

Presenter Organization Scripps Mercy Hospital

Presenting Author Pranay Bonagiri

Track Adult

Keywords

bullous pemphigoid

drug-induced

linagliptin

dulaglutide

DPP-4 inhibitors

autoimmune blistering disease

BP180 antibodies

BP230 antibodies

direct immunofluorescence

prednisone

Bullous Pemphigoid

Medication Trigger

Histology

Direct Immunofluorescence

BP180