Amy Attaway1, Tracey L Mersfelder2, Sakshi Vaishnav1, Joanne K Baker1. 1. Western Michigan University School of Medicine, Dept. of Internal Medicine, 1000 Oakland Drive, Kalamazoo, Michigan 49008-1284, USA; 2. Ferris State University, Dept. of Pharmacy, Borgess Hospital, 1521 Gull Rd Kalamazoo, MI 49048, USA.
Abstract
BACKGROUND: Bullous pemphigoid is a cutaneous autoimmune blistering disorder. The etiology for what precipitates this disease is not entirely clear at this point, although it has been associated with certain medications. MAIN OBSERVATION: We describe the case of a 70-year-old male with a past medical history of diabetes type 2 who developed a diffuse eruption of bullae with skin biopsy positive for bullous pemphigoid. He had previously been prescribed sitagliptin 50 mg daily for at least one year prior to onset of his disease. The medication was discontinued and the patient was treated with first IV and then oral steroids with good clinical outcome. There have been a few reports that have explored the relationship between DPP-IV inhibitors (gliptins) and bullous pemphigoid, including three case series and a report on sitagliptin associated allergic skin reactions submitted to the Adverse Event Reports System database of the FDA. According to the Naranjo ADR probability score there is a "possible" cause and effect relationship for this case. CONCLUSION: The enzyme DPP-IV is ubiquitously expressed in almost every organ system, including the skin. The exact mechanism at this time is unknown but is believed to be multifactorial involving many aspects of the immune system. Our case and the findings from our literature review further demonstrate a link between dipeptidyl peptidase-IV inhibitors and the development of bullous pemphigoid.
BACKGROUND: Bullous pemphigoid is a cutaneous autoimmune blistering disorder. The etiology for what precipitates this disease is not entirely clear at this point, although it has been associated with certain medications. MAIN OBSERVATION: We describe the case of a 70-year-old male with a past medical history of diabetes type 2 who developed a diffuse eruption of bullae with skin biopsy positive for bullous pemphigoid. He had previously been prescribed sitagliptin 50 mg daily for at least one year prior to onset of his disease. The medication was discontinued and the patient was treated with first IV and then oral steroids with good clinical outcome. There have been a few reports that have explored the relationship between DPP-IV inhibitors (gliptins) and bullous pemphigoid, including three case series and a report on sitagliptin associated allergic skin reactions submitted to the Adverse Event Reports System database of the FDA. According to the Naranjo ADR probability score there is a "possible" cause and effect relationship for this case. CONCLUSION: The enzyme DPP-IV is ubiquitously expressed in almost every organ system, including the skin. The exact mechanism at this time is unknown but is believed to be multifactorial involving many aspects of the immune system. Our case and the findings from our literature review further demonstrate a link between dipeptidyl peptidase-IV inhibitors and the development of bullous pemphigoid.
Authors: Gary A Herman; Arthur Bergman; Fang Liu; Cathy Stevens; Amy Q Wang; Wei Zeng; Li Chen; Karen Snyder; Deborah Hilliard; Michael Tanen; Wesley Tanaka; Alan G Meehan; Kenneth Lasseter; Stacy Dilzer; Robert Blum; John A Wagner Journal: J Clin Pharmacol Date: 2006-08 Impact factor: 3.126
Authors: Anja Thielitz; Siegfried Ansorge; Ute Bank; Michael Tager; Sabine Wrenger; Harald Gollnick; Dirk Reinhold Journal: Front Biosci Date: 2008-01-01
Authors: Marzia Caproni; Anna Calzolari; Elisabetta Salvatore; Barbara Giomi; Walter Volpi; Alberino D'Agata; Marco Santucci; Paolo Fabbri Journal: J Oral Pathol Med Date: 2003-01 Impact factor: 4.253
Authors: B Giacalone; L D'Auria; C Bonifati; C Ferraro; E Riccardi; A Mussi; G D'Agosto; P Cordiali-Fei; F Ameglio Journal: Exp Dermatol Date: 1998-08 Impact factor: 3.960
Authors: E Makrantonaki; D Jiang; A M Hossini; G Nikolakis; M Wlaschek; K Scharffetter-Kochanek; C C Zouboulis Journal: Rev Endocr Metab Disord Date: 2016-09 Impact factor: 6.514