Fabrazzo Michele, Boccardi Mariangela, Cipolla Salvatore, Galiero Raffaele, Tucci Claudia, Perris Francesco, Di Caprio Ester Livia, Catapano Francesco, Sasso Ferdinando Carlo
Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138 Naples, Italy.
Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138 Naples, Italy.
Brain Sci. 2021 Oct 22;11(11):1386. doi: 10.3390/brainsci11111386.
Neuropsychiatric disorders are found to be associated with bullous pemphigoid (BP), an autoimmune subepidermal blistering disease. Antipsychotics have emerged as possible inducing factors of BP. However, large sample studies concerning BP associated with antipsychotics, as well as with specific mental disorders, are still lacking. Our review retrieved a few clinical studies and case reports on the topic, producing controversial results. We report for the first time a bipolar patient case presenting BP following five-month therapy with risperidone long-acting injectable (LAI). We hypothesize that the dermatological event is associated with the medication administered. The issue emerged during psychiatric consultation and was confirmed by histological examination, direct and indirect immunofluorescence studies, plus positive plasma and cutaneous BP180 and BP230 IgG. Neurodegeneration or neuroinflammation might represent a primary process leading to a cross-reactive immune response between neural and cutaneous antigens and contributing to self-tolerance failure. Furthermore, the time sequence of the shared biological mechanisms leading to clinical manifestations of the neuropsychiatric disorder and BP remains undefined. BP comorbid with bipolar disorder might occasionally represent a serious health risk and affect patients' physical and psychosocial quality of life. Thus, clinicians treating psychiatric patients should consider BP as a possible adverse effect of psychotropic medications.
神经精神疾病被发现与大疱性类天疱疮（BP）相关，后者是一种自身免疫性表皮下疱病。抗精神病药物已成为BP可能的诱发因素。然而，关于与抗精神病药物以及特定精神障碍相关的BP的大样本研究仍然缺乏。我们的综述检索到了一些关于该主题的临床研究和病例报告，结果存在争议。我们首次报告了一例双相情感障碍患者在接受利培酮长效注射剂（LAI）治疗五个月后出现BP的病例。我们推测该皮肤事件与所使用的药物有关。该问题在精神科会诊期间出现，并通过组织学检查、直接和间接免疫荧光研究以及血浆和皮肤BP180和BP230 IgG阳性得到证实。神经退行性变或神经炎症可能代表一个导致神经和皮肤抗原之间交叉反应性免疫反应并导致自身耐受失败的主要过程。此外，导致神经精神疾病和BP临床表现的共同生物学机制的时间顺序仍不明确。与双相情感障碍共病的BP偶尔可能代表严重的健康风险，并影响患者的身体和心理社会生活质量。因此，治疗精神科患者的临床医生应将BP视为精神药物可能的不良反应。
