Bullous pemphigoid induced by vildagliptin: a case involving a maintenance hemodialysis patient

Abstract

An 80-year-old male, who was receiving maintenance hemodialysis, presented with extensive exudative erythema and pruritus on his right upper arm, which gradually extended to the left arm after eight months of treatment with vildagliptin for type 2 diabetes. A skin biopsy revealed bullous pemphigoid (BP). A high level of anti-BP180 autoantibodies (380) was detected. Oral prednisolone (PSL) and minocycline hydrochloride (MINO) treatment was started immediately. The skin lesions had improved markedly after two months of the PSL/MINO treatment. However, the vildagliptin treatment was continued. The skin lesions reappeared six months after the discontinuation of the PSL/MINO treatment. The PSL/MINO treatment was restarted. Coincidently, at this time it was reported that BP can occur as a side effect of vildagliptin in elderly Japanese type 2 diabetes patients (Pharmaceuticals and Medical Devices Safety Information). Vildagliptin was immediately discontinued. The skin lesions gradually resolved. The PSL/MINO treatment was discontinued. The patient’s BP had not relapsed at eight months after the withdrawal of vildagliptin.