Bae Y I, Yun S J, Lee S C, Park G T, Lee J B
Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea.
Clin Exp Dermatol. 2008 Nov;33(6):721-3. doi: 10.1111/j.1365-2230.2008.02857.x. Epub 2008 Jul 4.
A 76-year-old Korean woman presented with pruritic erythematous vesicles and crusted plaques over her entire body. She had been taking an angiotensin II receptor blocker (ARB) (candesartan) for 2 months before developing the skin lesions. The patients was diagnosed with pemphigus foliaceus based on the clinical and immunopathological criteria, including intra-epidermal bulla on skin histopathology, intercellular deposit of C(3) and IgG on direct immunofluorescence, and autoantibodies to the 160-kDa antigen on both immunoblot and ELISA. The medication was changed to another antihypertensive agent and the patient was treated with prednisolone for 2 months. The vesiculobullous skin lesions gradually disappeared. However, the skin lesions reappeared 2 months after starting a different ARB (telmisartan). This case illustrates the importance of taking a complete drug history in patients who present with bullous diseases. Furthermore, ARBs should be added to the list of nonthiol drugs that can possibly induce pemphigus.
一名76岁的韩国女性全身出现瘙痒性红斑水疱和结痂斑块。在出现皮肤病变前2个月，她一直在服用血管紧张素II受体阻滞剂（ARB）（坎地沙坦）。根据临床和免疫病理学标准，该患者被诊断为落叶型天疱疮，包括皮肤组织病理学上的表皮内水疱、直接免疫荧光显示的C3和IgG细胞间沉积，以及免疫印迹和酶联免疫吸附测定中针对160kDa抗原的自身抗体。药物换成了另一种抗高血压药，患者接受泼尼松龙治疗2个月。水疱性皮肤病变逐渐消失。然而，在开始使用另一种ARB（替米沙坦）2个月后，皮肤病变再次出现。该病例说明了对患有大疱性疾病的患者详细询问用药史的重要性。此外，ARB应被列入可能诱发天疱疮的非硫醇类药物清单。
