A Case of Supposed Drug-induced Pemphigus

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  • HAYASHI Shujiro
    Department of Dermatology, Dokkyo Medical University School of Medicine
  • HATAMOCHI Atsushi
    Department of Dermatology, Dokkyo Medical University School of Medicine
  • NAKANO Atsuko
    Department of Dermatology, Dokkyo Medical University School of Medicine
  • ISHIKAWA Satoko
    Department of Dermatology, Dokkyo Medical University School of Medicine
  • HAMASAKI Yoichiro
    Department of Dermatology, Dokkyo Medical University School of Medicine
  • YAMAZAKI Soji
    Department of Dermatology, Dokkyo Medical University School of Medicine
  • KONO Koichi
    Department of Hypertension and Cardiorenal Medicine, Dokkyo Medical University School of Medicine
  • ISHIKAWA Tomoko
    Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine
  • SAKAI Hideki
    Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine
  • IMAI Yutaka
    Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine

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Other Title
  • 非ＳＨ薬による薬剤誘発性天疱瘡と考えられた１例
  • 症例 非SH薬による薬剤誘発性天疱瘡と考えられた1例
  • ショウレイ ヒSHヤク ニ ヨル ヤクザイ ユウハツセイ テンポウソウ ト カンガエラレタ 1レイ

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A 75-year-old man had suffered from chronic renal failure, hypertension, diabetes mellitus, gastric ulcer, and myocardial infarction over several years. Imidapril-HCL and doxazosin mesilate therapy was begun one year previously. In addition he had taken 11 other medicines. He developed erosion of the oral cavity mucosa in August of 2008. After one week, coin lesions with erythema and erosion appeared on his trunk and limb. A biopsy of the involved glossa showed intra-epidermal bullae formation just above the basal epidermis. His serum was positive for anti-Deg 3 antibody (INDEX, 133). Therapy with 13 kinds of drugs was stopped, and prednisolone (PSL) 60 mg therapy was started. After ten days, only pigmentation of the previous lesions remained. He has presently stopped PSL therapy, but has never had a recurrence of these lesions. This case was assumed to be drug-induced pemphigus (DIP) based on clinical progress. There are 51 previously described DIP cases that had eruption of pemphigus which didn't have S-H groups in the structural formula of the contributory drugs. More than 70 percents of these drugs had active amide groups in their structural formula, like imidapril-HCl or doxazosin mesilate. Most of the eruption types were pemphigus vulgaris, varying from pemphigus foliaceus or pemphigus erythematosus.

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