Holi Aishwarya, Rijal Satya, Rayamajhi Sumugdha, Regmi Nikhil
Internal Medicine, Michigan State University College of Human Medicine, East Lansing, USA.
Cureus. 2025 May 31;17(5):e85144. doi: 10.7759/cureus.85144. eCollection 2025 May.
Drug-induced pemphigus (DIP) is a rare autoimmune blistering disorder most commonly associated with thiol-containing drugs such as penicillamine, captopril, and bucillamine. However, additional medications are increasingly recognized in the nonthiol nonphenol group. While some cases require treatment with corticosteroids or immunosuppressants, in certain instances, simply discontinuing the offending drug is sufficient. We report a unique case of drug-induced pemphigus foliaceus (DIPF) potentially triggered by piperacillin-tazobactam and/or linezolid in a 69-year-old female patient on the 10th day of hospitalization while receiving treatment for necrotizing fasciitis and bacteremia. To the best of our knowledge, this is the first reported case of DIP caused by piperacillin-tazobactam and/or linezolid. However, other factors may have predisposed them. The diagnosis of DIPF was confirmed through skin biopsy, direct immunofluorescence (DIF), and enzyme-linked immunosorbent assay (ELISA). Early recognition and prompt discontinuation of the suspected drugs likely prevented disease progression, emphasizing the importance of vigilance when managing patients on polypharmacy. While the exact mechanism of DIP remains unclear, potential pathways include antigen modification, immune dysregulation, or oxidative stress. This case highlights the need for heightened awareness of atypical triggers, comprehensive diagnostics, and timely intervention to optimize patient outcomes.
药物性天疱疮（DIP）是一种罕见的自身免疫性水疱性疾病，最常与含硫醇的药物有关，如青霉胺、卡托普利和布西拉明。然而，非硫醇非酚类药物中越来越多的药物被认为会引发该病。虽然有些病例需要用皮质类固醇或免疫抑制剂治疗，但在某些情况下，简单停用致病药物就足够了。我们报告了一例独特的药物性落叶型天疱疮（DIPF）病例，可能是由哌拉西林 - 他唑巴坦和/或利奈唑胺引发的，患者为一名69岁女性，在因坏死性筋膜炎和菌血症住院治疗的第10天出现症状。据我们所知，这是首例由哌拉西林 - 他唑巴坦和/或利奈唑胺引起的DIP报告病例。然而，可能还有其他因素促使发病。通过皮肤活检、直接免疫荧光（DIF）和酶联免疫吸附测定（ELISA）确诊为DIPF。早期识别并及时停用可疑药物可能预防了疾病进展，强调了在管理使用多种药物的患者时保持警惕的重要性。虽然DIP的确切机制尚不清楚，但潜在途径包括抗原修饰、免疫失调或氧化应激。该病例突出了提高对非典型触发因素的认识、进行全面诊断和及时干预以优化患者预后的必要性。
