Alam Mohd Rashid, Singh Samant, Agarwal Astha, Prithviraj Manoj, Tripathi Richa
Psychiatry, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND.
Cureus. 2024 Sep 10;16(9):e69125. doi: 10.7759/cureus.69125. eCollection 2024 Sep.
The patient, a 64-year-old male with a history of delusional disorder, first experienced symptoms of suspicion toward his spouse at age 34. He was treated with psychotropic drugs for two years, leading to complete symptom remission and discontinuation of medication. After years of stability, delusions resurfaced two years ago. Amisulpride was ineffective, and risperidone was started but led to itching and plaques on his thighs, which evolved into fluid-filled and hemorrhagic lesions. Diagnosed with bullous pemphigoid (BP) via skin biopsy, he received corticosteroids, dapsone, and antibiotics. Risperidone was discontinued, but delusions reappeared, prompting its reintroduction. New bullous lesions emerged, suggesting risperidone's role in triggering them. Risperidone was replaced with aripiprazole, and melatonin improved sleep. The patient responded well, with both delusional symptoms and skin condition well-managed. This case highlights the need to consider drug-induced BP in elderly patients on antipsychotic medications.
该患者为一名64岁男性，有妄想症病史，34岁时首次出现对其配偶的怀疑症状。他接受了两年的精神药物治疗，症状完全缓解并停药。经过多年的病情稳定，妄想症在两年前复发。氨磺必利治疗无效，开始使用利培酮，但导致他大腿出现瘙痒和斑块，进而发展为充满液体和出血性的病变。通过皮肤活检诊断为大疱性类天疱疮（BP），他接受了皮质类固醇、氨苯砜和抗生素治疗。利培酮停药，但妄想症再次出现，促使重新使用利培酮。新的大疱性病变出现，提示利培酮在引发这些病变中起作用。利培酮被阿立哌唑替代，褪黑素改善了睡眠。患者反应良好，妄想症状和皮肤状况均得到良好控制。该病例强调了在使用抗精神病药物的老年患者中需要考虑药物性BP。
