Dulaglutide

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Hypersensitivity reaction in the form of morbilliform drug eruptions: case report An 84-year-old man developed hypersensitivity reaction in the form of morbilliform drug eruptions during treatment with dulaglutide for type 2 diabetes mellitus. The man presented to an emergency department due to occurrence of a rash. Two weeks prior to this presentation, the rash started to appear on his legs and then gradually spread upwards to his trunk, neck and to the upper extremities. His medical history was significant for type 2 diabetes mellitus, hyperlipidaemia, hypertension and back pain. At this presentation, he reported pruritus and a burning sensation on the skin and inside the mouth. He also reported no recent illnesses or tick bites. Upon a re-review of his medicinal history, it was noted that, 5 weeks prior to the onset of the skin symptoms (rash), he had started receiving dulaglutide for type 2 diabetes mellitus [dosage and route not stated]. At this presentation, he reported no arthralgias, myalgias, gastrointestinal symptoms, nausea, vomiting or fevers. A physical examination revealed coalescing pink macules and papules in a morbilliform pattern that affected his lower extremities, abdomen, neck, upper extremities and the back. He also had purpuric discoloration of dependent lesions on his lower extremities and non-blanching petechiae on the bilateral palms. His buccal mucosa was found to be erythematous without any erosions. A punch biopsy revealed interface dermatitis with eosinophils in the dermal inflammatory infiltrate, which suggested a hypersensitivity reaction. Other investigations (i.e. complete blood cell count, blood chemistry and liver functions tests) were found to be within normal limits. Based upon the clinical presentation and the above-mentioned laboratory results, he was diagnosed with hypersensitivity reaction in the form of morbilliform drug eruptions. The man’s therapy with dulaglutide was therefore discontinued, and he was treated with triamcinolone and prednisone. A quick resolution of the rash was observed following cessation of dulaglutide. He remained free of the rash thereafter. He denied re-trial of dulaglutide. As per the Naranjo drug causality assessment criteria, a ’probable’ association between dulaglutide and morbilliform drug eruptions was assessed (a score of 5). Rzepka PV, et al. A CASE of MORBILLIFORM DRUG ERUPTION to DULAGLUTIDE. Journal of Clinical and Aesthetic Dermatology 13: 13, No. 4, 01 Apr 2020. 803503325 Available from: URL: https://jcadonline.com/morbilliform-eruption-dulaglutide/

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Reactions 26 Sep 2020 No. 1823