Bullous Pemphigoid Associated with Aspirin Drug Reaction: A Case Report

Abstract

<p>一位有橫斷性脊髓炎病史規律服用免疫抑制劑移護寧(azathioprine)的64歲男性，因心房顫動以阿斯匹靈(aspirin)治療約一年，來到門診主訴軀幹和大腿出現散佈性紅疹和水泡，經診所開立的抗生素和抗病毒藥物治療未改善，以蜂窩性組織炎診斷收治住院，隨後皮膚切片檢查證實為類天皰瘡，經評估停用阿斯匹靈並以靜脈注射類固醇治療，症狀好轉後出院，並持續接受門診追蹤。類天皰瘡為好發於70歲以上老年人的自體免疫疾病，隨著人口老化、多重共病以及可能引發此疾病的藥物增加，類天皰瘡的發病率在過去幾十年中有所增加，阿斯匹靈在病理機轉上也被指出可能引發類天皰瘡，雖然目前的系統性回顧顯示兩者之間並沒有顯著相關，但有鑒於新藥開發，藥物誘發性皮膚反應增多，若發現病人皮膚出現水泡，合併發燒、喘、低血壓、皮膚疼痛、大面積脫皮或成灰紫色，侵犯眼睛、咽喉或消化道黏膜等應立即停用可能誘發此皮膚表現的藥物，並轉介專科醫師。類天皰瘡的治療以類固醇和免疫抑制劑為主，長期使用可能增加高血壓、糖尿病、骨質疏鬆與感染等風險，病人於後續門診追蹤，基層醫師評估皮膚病灶改善狀況，以每2-3週的頻率減低藥物劑量，並根據病人的年齡和狀況安排藥物相關副作用的檢查。</p> <p> </p><p>A 64-year-old male with a history of transverse myelitis and regular use of immunosuppressive agent azathioprine presented to our outpatient clinic with a complaint of disseminated erythematous rash and blisters on the trunk and thighs. He had been treated with aspirin for atrial fibrillation for about a year. Despite treatment with antibiotics and antiviral medications prescribed by the clinic, the symptoms did not improve, and he was admitted to the hospital with a diagnosis of cellulitis. Subsequent skin biopsy confirmed the diagnosis of bullous pemphigoid. After further assessments, aspirin was discontinued, and intravenous corticosteroid therapy was initiated, leading to symptom improvement. The patient was later discharged for follow-up in the outpatient clinic. Bullous pemphigoid is an autoimmune disease that predominantly affects elderly individuals aged 70 and above. Due to multiple comorbidities and increased use of medications that may trigger this disease, the incidence of bullous pemphigoid has been on the rise in recent decades among the elderly population. Aspirin has been suggested to be a potential trigger for bullous pemphigoid in its pathophysiology. Although current systematic reviews do not show a significant association between the two, the increased development of drug-induced skin reactions with the advent of new medications warrants caution. If a patient develops blisters on the skin, along with fever, wheezing, hypotension, skin pain, extensive peeling, or a grayish-purple discoloration, or if the condition affects the eyes, throat, or gastrointestinal mucosa, the medication potentially causing this skin manifestation should be discontinued immediately, and the patient should be referred to a specialist. </p> <p> The treatment of bullous pemphigoid primarily involves steroids and immunosuppressive agents. Long-term use of these medications may increase the risk of side effects such as hypertension, diabetes, osteoporosis, and infections. After patients return to outpatient follow-up, primary care physicians should carefully assess whether the skin lesions have improved. Medication dosage should be gradually reduced with a frequency of every 2-3 weeks, and examinations for medication-related side effects should be arranged based on the patient’s age and condition.</p> <p> </p>