Pemphigus foliaceus induced by an angiotensin II receptor blocker.
A 76-year-old Korean woman presented with pruritic erythematous vesicles and crusted plaques over her entire body. She had been taking an angiotensin II receptor blocker (ARB) (candesartan) for 2 months before developing the skin lesions. The patients was diagnosed with pemphigus foliaceus based on the clinical and immunopathological criteria, including intra-epidermal bulla on skin histopathology, intercellular deposit of C(3) and IgG on direct immunofluorescence, and autoantibodies to the 160-kDa antigen on both immunoblot and ELISA. The medication was changed to another antihypertensive agent and the patient was treated with prednisolone for 2 months. The vesiculobullous skin lesions gradually disappeared. However, the skin lesions reappeared 2 months after starting a different ARB (telmisartan). This case illustrates the importance of taking a complete drug history in patients who present with bullous diseases. Furthermore, ARBs should be added to the list of nonthiol drugs that can possibly induce pemphigus.
Bae
Y I
YI
Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea.
Yun
S J
SJ
Lee
S C
SC
Park
G T
GT
Lee
J B
JB
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects* / Q000627:therapeutic use; D001562:Benzimidazoles / Q000009:adverse effects* / Q000627:therapeutic use; D001565:Benzoates / Q000009:adverse effects; D001713:Biphenyl Compounds; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000276:immunology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D010392:Pemphigus / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D011239:Prednisolone / Q000627:therapeutic use; D000077333:Telmisartan; D013777:Tetrazoles / Q000009:adverse effects* / Q000627:therapeutic use
D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001565:Benzoates; D001713:Biphenyl Compounds; D007166:Immunosuppressive Agents; D013777:Tetrazoles; D011239:Prednisolone; C081643:candesartan; D000077333:Telmisartan