Drug-induced Linear Immunoglobulin A Bullous Disease That Clinically Mimics Toxic Epidermal Necrolysis

A critical reappraisal of the current data on drug-induced linear immunoglobulin A bullous dermatosis: A real and separate nosological entity?

“…In total, 52 patients with LAD were described: 28 (53.8%) induced by medications other than vancomycin 7-32 and 24 (46.2%) by vancomycin. [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] All demographic characteristics and immunohistopathological assessments are summarized in Table II.…”

“…[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] The male-female ratio was 1:1, and the age ranged from 32 to 92 years with a mean of 64.7 years (SD: 14.6; 95% CI: 58.6-70.9). Vancomycin turned out to be the most incriminated drug capable of inducing disease when compared with each single drug, that is, captopril (OR: 14; 95% CI: 3.86-50.72; P \ .0001) and, to a lesser extent, even with all drugs overall (OR: 0.73; 95% CI: 0.33-1.59; P = .55).…”

Vancomycin-induced linear IgA bullous disease presenting as toxic epidermal necrolysis

“…[1][2][3][4][5][6][7][8][9] The clinical presentations of both idiopathic and drug-related LABD are variable and may mimic other blistering disorders, such as bullous pemphigoid, dermatitis herpetiformis, cicatricial pemphigoid, erythema multiforme and toxic epidermal necrolysis (TEN). [1][2][3][4][5][6][7][8][9] The aetiology of LABD is still not fully elucidated, but multiple antigens including97 kDa, 120 kDa, 180 kDa, 230 kDa, and 280 kDa have been reported as potential targets for the immune response. [10][11][12] We present a case of a 77-year-old man who presented with vancomycin-induced LABD that mimicked TEN.…”

“…Clinically, both idiopathic and drug-induced LABD mimic other blistering disorders, which can make it difficult to diagnose. [1][2][3][4][5][6][7][8][9] In drug-induced LABD, the onset of blisters usually occurs within 7-15 days with a mean onset of 8 days and resolution within 2-7 weeks upon drug withdrawal. 3 Drug-induced LABD has some differences when compared to the idiopathic variant.…”

“…3 There have been seven cases of drug-iduced LABD that have clinically mimicked or resembled TEN (Table 1). 2,[5][6][7][8][9] All patients except for two had been on vancomycin for at least 1 week. In the case reported by Paul et al there was a clear distinction from the time that diclofenac, a new medication, was started and eruption first appeared.…”