Sitagliptin
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Exacerbation of bullous pemphigoid: case report A 90-year-old man had an exacerbation of bullous pemphigoid during treatment with sitagliptin for type 2 diabetes mellitus. The man, who had untreated type 2 diabetes for 30 years, presented with itchy blistering skin lesions on his trunk and limbs for 1 month. He tested positive for anti-BP180 NC16A antibodies. Based on the results of histopathology of a skin biopsy and direct immunofluorescence analysis he was diagnosed with bullous pemphigoid and his treatment was started with prednisolone and minocycline. Ten months later, when the skin condition was stable on prednisolone monotherapy, he started receiving sitagliptin [route and dosage not stated]. One month later, several infiltrative erythemas, erosions and blisters developed over his entire body (exacerbation of bullous pemphigoid). The anti-BP180 NC16A antibody titre was found to be increased further. He was then hospitalised. The sitagliptin therapy was stopped .The man’s therapy was again started with minocycline and increased dose of prednisolone. In spite of this, new blisters developed and erythematous areas continued to develop. Thereafter, he was treated with IV immune globulin for 5 days. Thereafter, the skin lesions improved slowly along with a drop in the titres of anti-BP180 NC16A antibodies. Even though the dose of steroid was tapered, the skin lesions were not completely suppressed. After 37 weeks from the exacerbation of bullous pemphigoid, he developed sepsis with disseminated intravascular coagulation. Eventually, he died of multiple organ failure. Author comment: "In the present case, [bullous pemphigoid] that had been stable on a low dose of steroid showed exacerbation of exanthemas with a rapid rise in the level of anti-BP180 NC16A autoantibodies 1 month after administration of DPP4i [sitagliptin]". Nishiyama C, et al. Exacerbation of well-controlled bullous pemphigoid by the administration of a dipeptidyl peptidase-4 inhibitor. Clinical and Experimental Dermatology 44: 830-832, No. 7, Oct 2019. Available from: URL: http:// 803431567 doi.org/10.1111/ced.13962 - Japan
0114-9954/19/1777-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 2 Nov 2019 No. 1777
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