Case Report: Bullous Pemphigoid and the Association with Dipeptidyl-peptidase 4 Inhibitors

Abstract

<p>大皰性類天皰瘡(bullous pemphigoid)是一種自體免疫表皮下水泡疾病，表現為全身性瘙癢性蕁麻疹斑塊和緊繃的表皮下水泡。發生率大約每百萬人年為4至22例個案，而且有逐漸增加之趨勢。這種疾病最常影響老年人，除了老年化社會增加罹患風險外，神經疾病增加、與可能誘發類天皰瘡之藥物使用增加皆與該疾病增加的趨勢有關。</p> <p>本個案為一位90歲的女性，過去疾病包括小腦出血性中風、帕金森氏症、失智症、高血壓、及糖尿病。糖尿病於一年前新診斷並開始使用 linagliptin及glimepiride等藥物控制血糖。主訴近半年多來開始會有全身的癢疹，尤其是軀幹及四肢，兩週前開始在皮膚縐摺處出現水泡及破裂傷口，經過臨床檢驗後診斷為大皰性類天皰瘡，搜索相關文獻後懷疑與 Linagliptin 的使用有關，於是改用其他藥物控制血糖，並開始使用外用及口服類固醇治療。經治療後皮膚明顯改善，不再有新水泡產生。本個案報告簡介大皰性類天皰瘡，亦討論該疾病與降血糖藥物dipeptidyl-peptidase 4 inhibitors (DPP4-inhibitor)之關係，研究發現某些類型的DPP4-inhibitor例如linagliptin與大皰性類天皰瘡的發生機率相關。</p> <p> </p><p>Bullous pemphigoid is an autoimmune subepidermal blistering disease characterized by generalized pruritic urticarial plaques and tense subepidermal blisters. The incidence is approximately 4 to 22 cases per million people per year, with a rising trend. This disease predominantly affects the elderly, and the increasing trend is attributed to the aging population, rising incidence of neurological disorders, and the use of medications that may trigger bullous pemphigoid.</p> <p>This case is a 90-year-old female with a medical history of cerebellar hemorrhagic stroke, Parkinson’s disease, dementia, hypertension, and diabetes. Diabetes was newly diagnosed a year ago, and medications like linagliptin and glimepiride were initiated for blood sugar control. The patient complained of generalized itching and rash for the past six months, particularly on the trunk and limbs. Two weeks ago, blisters and ruptured wounds appeared in the skin folds. After clinical examination, the diagnosis of bullous pemphigoid was made. After reviewing relevant literature, it was suspected to have connection with the use of linagliptin and bullous pemphigoid. We shifted linagliptin to other drugs to control blood sugar, and topical and oral corticosteroid treatment was initiated. The skin significantly improved after treatment. This case report not only introduces bullous pemphigoid but also discusses the association between this disease and dipeptidyl-peptidase 4 inhibitors (DPP-4 inhibitors). Research suggests a correlation between certain types of DPP-4 inhibitors, such as linagliptin, and the occurrence of bullous pemphigoid.</p> <p> </p>