Attaway Amy, Mersfelder Tracey L, Vaishnav Sakshi, Baker Joanne K
Western Michigan University School of Medicine, Dept. of Internal Medicine, 1000 Oakland Drive, Kalamazoo, Michigan 49008-1284, USA;
Ferris State University, Dept. of Pharmacy, Borgess Hospital, 1521 Gull Rd Kalamazoo, MI 49048, USA.
J Dermatol Case Rep. 2014 Mar 31;8(1):24-8. doi: 10.3315/jdcr.2014.1166.
Bullous pemphigoid is a cutaneous autoimmune blistering disorder. The etiology for what precipitates this disease is not entirely clear at this point, although it has been associated with certain medications.
We describe the case of a 70-year-old male with a past medical history of diabetes type 2 who developed a diffuse eruption of bullae with skin biopsy positive for bullous pemphigoid. He had previously been prescribed sitagliptin 50 mg daily for at least one year prior to onset of his disease. The medication was discontinued and the patient was treated with first IV and then oral steroids with good clinical outcome. There have been a few reports that have explored the relationship between DPP-IV inhibitors (gliptins) and bullous pemphigoid, including three case series and a report on sitagliptin associated allergic skin reactions submitted to the Adverse Event Reports System database of the FDA. According to the Naranjo ADR probability score there is a "possible" cause and effect relationship for this case.
The enzyme DPP-IV is ubiquitously expressed in almost every organ system, including the skin. The exact mechanism at this time is unknown but is believed to be multifactorial involving many aspects of the immune system. Our case and the findings from our literature review further demonstrate a link between dipeptidyl peptidase-IV inhibitors and the development of bullous pemphigoid.
大疱性类天疱疮是一种皮肤自身免疫性水疱病。尽管该病与某些药物有关，但目前引发该病的病因尚不完全清楚。
我们描述了一例70岁男性病例，该患者有2型糖尿病病史，出现了大疱性弥漫性皮疹，皮肤活检显示大疱性类天疱疮阳性。在发病前至少一年，他曾每日服用50毫克西格列汀。停用该药物后，患者先接受静脉注射，然后口服类固醇治疗，临床效果良好。已有一些报告探讨了二肽基肽酶-4抑制剂（格列汀类）与大疱性类天疱疮之间的关系，包括三个病例系列以及一份提交给美国食品药品监督管理局不良事件报告系统数据库的关于西格列汀相关过敏性皮肤反应的报告。根据纳朗霍药物不良反应概率评分，该病例存在“可能”的因果关系。
二肽基肽酶-4在几乎每个器官系统（包括皮肤）中均有广泛表达。目前确切机制尚不清楚，但认为是多因素的，涉及免疫系统的多个方面。我们的病例以及文献综述结果进一步证明了二肽基肽酶-4抑制剂与大疱性类天疱疮发病之间的联系。
