Abstract
Diabetes mellitus tedavisinde kullanılan bir dipeptidil peptidaz IV inhibitörü olan linagliptin, kan üre düzeylerinde artış, lipaz düzeylerinde artış, artralji, dermatolojik reaksiyonlar, kalp yetmezliği ve aşırı duyarlılık reaksiyonları ile ilişkilendirilmiştir. 68 yaşında bir kadın hasta acil servise ciltte kaşıntılı, kabarık ve hemorajik büllöz döküntülerle başvurmuştur. Hastanın tıbbi geçmişinde diabetes mellitus, hipertansiyon ve böbrek yetmezliği vardı ve üç hafta önce linagliptin tedavisine başladığı kaydedildi. Hastanın tam kan sayımı ve biyokimyasında özellik yoktu. Fizik muayenede boyunda, ensede, gövdede ve her iki uylukta içi sıvı dolu lezyonlar görüldü. Oral ve genital mukozanın muayenesi normaldi. Hastada eroziv hemorajik büller vardı ve Nikolsky belirtisi negatifti. Dermatoloji bölümüyle yapılan konsültasyonun ardından deri biyopsisi planlanmış ve dahiliye bölümüyle yapılan konsültasyonun ardından mevcut klinik durumun linagliptine bağlı olduğu öne sürülmüş ve ilacın kesilmesi önerilmiştir. Büllöz lezyonlar genellikle otoimmün etiyolojilerle ilişkilidir ve iki hafta ile beş ay arasında görülür. Ancak subepidermal vakalarda hemorajik klinik özelliklerin prognozu hemorajik olmayanlara kıyasla daha ölümcül ve morbiddir. Literatürde linagliptin kullanımını takiben çeşitli dermatolojik semptomlar ve büllöz pemfigus bildirilmişken, olgumuz hemorajik büllöz pemfigus olarak tanımlanmıştır.
Ethical Statement
Çalışmada adı geçen yazarların herhangi bir çıkar ilişkisi yoktur. Herhangi bir kurul-kurum-kuruluşla ilgisi yoktur.
Supporting Institution
Yayını destekleyen kurum yoktur.
Thanks
Patolojik görüntülemeler için Dr. Betül Şimşek'e teşekkür ederiz.
References
- Felner EI, Klitz W, Ham M, Lazaro AM, Stastny P, Dupont B et al. Genetic interaction among three genomic regions creates distinct contributions to early- and late-onset type 1 diabetes mellitus. Pediatr Diabetes. 2005;6:213-20.
- Sapra A, Bhandari P. Diabetes. StatPearls. Treasure Island (FL), Stat Pearls Publishing, 2023.
- Umpierre D, Ribeiro PA, Kramer CK, Leitao CB, Zucatti AT, Azevedo MJ et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011;305:1790-9.
- Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.
- McGill JB. Linagliptin for type 2 diabetes mellitus: a review of the pivotal clinical trials. Ther Adv Endocrinol Metab. 2012;3:113-24.
- Bene J, Moulis G, Bennani I, Auffret M, Coupe P, Babai S et al. Bullous pemphigoid and dipeptidyl peptidase IV inhibitors: a case-noncase study in the French Pharmacovigilance Database. Br J Dermatol. 2016;175:296-301.
- Giavina-Bianchi P, Arruda LK, Aun MV, Campos RA, Chong-Neto HJ, Constantino-Silva RN et al. Brazilian Guidelines for Hereditary Angioedema Management - 2017 Update Part 1: definition, classification and diagnosis. Clinics (Sao Paulo). 2018;73:e310.
- Vaillant L, Bernard P, Joly P, Prost C, Labeille B, Bedane C et al. Evaluation of clinical criteria for diagnosis of bullous pemphigoid. French Bullous Study Group. Arch Dermatol. 1998;134:1075-80.
- Baigrie D, Nookala V. Bullous Pemphigoid. StatPearls. Treasure Island (FL), Stat Pearls Publishing, 2023.
- Hsiao CT, Lin LJ, Shiao CJ, Hsiao KY, Chen IC. Hemorrhagic bullae are not only skin deep. Am J Emerg Med. 2008;26:316-9.
- Tanaka H, Ishii T. Analysis of patients with drug-induced pemphigoid using the Japanese Adverse Drug Event Report database. J Dermatol. 2019;46:240-4
Abstract
Linagliptin, a dipeptidyl peptidase IV inhibitor used to treat diabetes mellitus, has been associated with increased blood urea levels, increased lipase levels, arthralgia, dermatological reactions, heart failure and hypersensitivity reactions. A 68-year-old female patient presented to the emergency department with pruritic, raised, and hemorrhagic bullous eruptions on the skin. The patient's medical history included diabetes mellitus, hypertension and renal failure, and it was noted that she had started linagliptin therapy three weeks previously. The patient's complete blood count and biochemistry were unremarkable. Physical examination revealed fluid-filled lesions on the neck, back of the neck, trunk and both thighs. Examination of the oral and genital mucosa was normal. The patient had erosive haemorrhagic bullae and the Nikolsky sign was negative. After consultation with the dermatology department, a skin biopsy was planned, and after consultation with the internal medicine department, it was suggested that the current clinical condition was linagliptin-dependent and discontinuation of the medication was recommended. Bullous lesions are often associated with autoimmune etiologies and are observed between two weeks and five months. However, in subepidermal cases, the prognosis of haemorrhagic clinical features is more fatal and morbid compared to non-haemorrhagic ones. Various dermatological symptoms and bullous pemphigus have been reported in the literature following the use of linagliptin, whereas our case was a haemorrhagic bullous pemphigus.
References
- Felner EI, Klitz W, Ham M, Lazaro AM, Stastny P, Dupont B et al. Genetic interaction among three genomic regions creates distinct contributions to early- and late-onset type 1 diabetes mellitus. Pediatr Diabetes. 2005;6:213-20.
- Sapra A, Bhandari P. Diabetes. StatPearls. Treasure Island (FL), Stat Pearls Publishing, 2023.
- Umpierre D, Ribeiro PA, Kramer CK, Leitao CB, Zucatti AT, Azevedo MJ et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011;305:1790-9.
- Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.
- McGill JB. Linagliptin for type 2 diabetes mellitus: a review of the pivotal clinical trials. Ther Adv Endocrinol Metab. 2012;3:113-24.
- Bene J, Moulis G, Bennani I, Auffret M, Coupe P, Babai S et al. Bullous pemphigoid and dipeptidyl peptidase IV inhibitors: a case-noncase study in the French Pharmacovigilance Database. Br J Dermatol. 2016;175:296-301.
- Giavina-Bianchi P, Arruda LK, Aun MV, Campos RA, Chong-Neto HJ, Constantino-Silva RN et al. Brazilian Guidelines for Hereditary Angioedema Management - 2017 Update Part 1: definition, classification and diagnosis. Clinics (Sao Paulo). 2018;73:e310.
- Vaillant L, Bernard P, Joly P, Prost C, Labeille B, Bedane C et al. Evaluation of clinical criteria for diagnosis of bullous pemphigoid. French Bullous Study Group. Arch Dermatol. 1998;134:1075-80.
- Baigrie D, Nookala V. Bullous Pemphigoid. StatPearls. Treasure Island (FL), Stat Pearls Publishing, 2023.
- Hsiao CT, Lin LJ, Shiao CJ, Hsiao KY, Chen IC. Hemorrhagic bullae are not only skin deep. Am J Emerg Med. 2008;26:316-9.
- Tanaka H, Ishii T. Analysis of patients with drug-induced pemphigoid using the Japanese Adverse Drug Event Report database. J Dermatol. 2019;46:240-4
Details
| Primary Language | English |
|---|---|
| Subjects | Emergency Medicine, Dermatology, Internal Diseases |
| Journal Section | Letter to the Editor |
| Authors | |
| Publication Date | December 30, 2024 |
| Submission Date | December 30, 2023 |
| Acceptance Date | February 23, 2024 |
| Published in Issue | Year 2024 Volume: 49 Issue: 4 |
