Lisinopril‐associated bullous pemphigoid in an elderly woman: a case report of a rare adverse drug reaction

Abstract

An 87-year-old woman with a long-standing history of hypertension, hypothyroidism and diabetes presented to us with scaly and pruritic vesicles of an erythematous base and crusted surface of 2-month duration. They first appeared on her abdomen and gradually spread to her lower back, thighs, before spreading to her upper and lower limbs. Her lesions were non-painful, aggravated by sun exposure only, and sparing mucous membranes. Nikolsky sign was positive with no discernible fluid-filled bullae. History was remarkable only for a doubling of her Lisinopril dosage 2 months prior to the appearance of her lesions, with no other potential environmental and/or drug triggers recognizable on history taking. In light of the appearance of her lesions after her Lisinopril dose escalation, in the absence of any other discernible triggers, an adverse drug reaction (ADR) was entertained, yielding a corresponding Naranjo ADR probability score of 7. Particularly, drug-induced pemphigus foliaceus was initially suspected given her clinical presentation and the morphology and distribution of her lesions. However, her skin biopsy altered our diagnosis to drug-induced bullous pemphigoid (BP) instead, making this the second case reported to date on Lisinopril-induced BP, and the first to report a dose-response variant of this adverse reaction.

New-Onset Bullous Pemphigoid in a COVID-19 Patient

“…It is important to recognize that individuals with a genetic predisposition who are exposed to certain medications may develop drug-induced BP, including DPV inhibitors such as vildagliptin and linagliptin and certain diuretic medications such as furosemide and spironolactone, as well as certain antipsychotic medications and checkpoint inhibitors [ 10 ]. The second class of drugs that has been associated with bullous pemphigoid is angiotensin-converting enzyme inhibitors, or ACE-Is, specifically losartan, valsartan, and lisinopril [ 11 ]. Interestingly, our patient had been taking lisinopril.…”

“…e case report, meta-analysis, and scientific data used to support the findings of this study are included within this study. ese prior studies are cited at relevant places within the text as references [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Neu aufgetretenes bullöses Pemphigoid bei einer Patientin mit COVID-19

“…Es ist wichtig daran zu denken, dass Menschen mit entsprechender genetischer Prädisposition bei Exposition gegenüber bestimmten Medikamenten, da­runter DPV-Inhibitoren wie Vildagliptin und Linagliptin, bestimmte Diuretika wie Furosemid und Spironolacton sowie bestimmte Antipsychotika und Checkpoint-Inhibitoren, ein arzneimittelinduziertes BP entwickeln können [ 10 ]. Die zweite mit bullösem Pemphigoid assoziierte Wirkstoffklasse sind Angiotensin-Converting-Enzyme-Inhibitoren (ACE-Hemmer), insbesondere Losartan, Valsartan und Lisinopril [ 11 ]. Interessant ist, dass unsere Patientin Lisinopril eingenommen hatte.…”

“…Der Fallbericht, die Metaanalyse und die wissenschaftlichen Daten, die zur Untermauerung der Ergebnisse dieser Studie herangezogen wurden, wurden in der vorliegenden Arbeit berücksichtigt. Die früheren Studien werden an den entsprechenden Stellen im Text als Referenzen zitiert [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

Treatment of refractory bullous pemphigoid with IFN‐α‐2b: A case report

“…At first, the patient was given 1.0 mg/kg/day prednisolone and 1,500 mg tetracycline for 1 week. However, the area of the rash rapidly expanded and Nikolsky sign was positive, which was rare in BP but not unusual in refractory BP (Ballout, Musharrafieh, & Khattar, ). The level of eosinophils increased to 7.39 × 10 9 /L (normal is <0.52 × 10 9 /L) and the serum IgE was 1,458 IU/mL (normal is <100 IU/mL).…”