SHM Converge Scientific Abstract ePoster Gallery-Drug-Induced Bullous Pemphigoid Triggered by GLP-1 Receptor Agonist

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This case report describes a 46-year-old man with chronic kidney disease stage 3b, type 2 diabetes, and autoimmune markers (positive ANA and SSA antibodies) who developed bullous pemphigoid after starting tirzepatide, a GLP-1 receptor agonist. He had previously been taking sitagliptin, which was stopped and replaced with tirzepatide for better glycemic control.<br /><br />Soon after tirzepatide initiation, the patient developed a diffuse, intensely pruritic rash that progressed to tense bullae on the extremities, abdomen, and groin, without mucosal involvement. Laboratory testing showed peripheral eosinophilia and elevated ESR. Skin biopsy demonstrated subepidermal blistering with an eosinophil-rich inflammatory infiltrate, confirming bullous pemphigoid.<br /><br />Tirzepatide was discontinued, and the patient was treated with prednisone, doxycycline, niacinamide, and biweekly dupilumab. His lesions resolved, leaving only post-inflammatory hyperpigmentation, supporting a diagnosis of drug-induced bullous pemphigoid.<br /><br />The report highlights that while DPP-4 inhibitors are a well-known trigger of bullous pemphigoid, GLP-1 receptor agonists such as tirzepatide may also induce this autoimmune blistering disease, though this association is rare and underrecognized. The authors suggest that pre-existing autoimmune predisposition and chronic kidney disease may increase susceptibility. Clinicians should consider drug-induced bullous pemphigoid in patients who develop new blistering eruptions after medication changes, and prompt biopsy, drug withdrawal, and dermatology referral can improve outcomes.

Asset Subtitle

Kendall Conway

Meta Tag

Author List Kathren Shango, Kendall Conway, Reshma Reguram

Category Clinical Vignettes

Concept Bullous Pemphigoid

Concept Drug-Induced Bullous Pemphigoid

Concept Bulla

Concept Subepidermal Blistering

Concept Drug Discontinuation

Distinguished Non-Finalist

Presenter Organization Wayne State University School of Medicine

Presenting Author Kendall Conway

Track Adult

Keywords

bullous pemphigoid

tirzepatide

GLP-1 receptor agonist

drug-induced autoimmune blistering disease

type 2 diabetes

chronic kidney disease

eosinophilia

skin biopsy

dupilumab

doxycycline

Bullous Pemphigoid

Drug-Induced Bullous Pemphigoid

Bulla

Subepidermal Blistering

Drug Discontinuation