Dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid, likely triggered by scabies, in a hemodialysis patient with human leukocyte antigen-DQB1*03:01
Dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid, likely triggered by scabies, in a hemodialysis patient with human leukocyte antigen-DQB1*03:01
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DOI：
10.1007/s13730-020-00452-2
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发表时间：
2020-01-28
期刊：
影响因子：
1
通讯作者：
Nakagawa, Takahiko
中科院分区：
文献类型：
--
作者：
Hibi, Arata;Kasahara, Yuto;Nakagawa, Takahiko
大疱性类天疱疮（BP）是最常见的自身免疫性表皮下大疱性疾病。针对半桥粒粘附蛋白的自身抗体可能参与了发育过程。血压通常影响老年人且死亡率较高，而药物引起的血压在停药后通常会得到改善且很少复发。积累的证据表明，二肽基肽酶 4 抑制剂 (DPP-4I) 已被广泛用作抗糖尿病药物，可改善血糖控制，且低血糖风险很小，可能是 DPP-4I 相关血压 (DPP-4I-BP) 的诱导剂。虽然确切的机制尚不清楚，但人类白细胞抗原 (HLA)-DQB1*03:01 的独特免疫学特征可能是 DPP-4I-BP 遗传易感性的生物标志物。在这里，我们遇到了一个有趣的 DPP-4I-BP 与 HLA-DQB1*03:01 病例，这可能是由疥疮触发的。一名56岁日本男性，患有2型糖尿病，正在接受血液透析，因水泡恶化被转诊至我院。入院前，他已服用 DPP-4I 利格列汀 5 个月。入院前两周，他出现疥疮，伊维菌素治疗未能改善症状。根据其临床症状、血清抗BP180自身抗体阳性以及皮肤活检标本的病理改变，诊断为DPP-4I-BP。重要的是，他还携带 HLA-DQB1*03:01 等位基因。停用利格列汀后口服泼尼松龙，症状逐渐消失。鉴于 DPP-4I-BP 可能是一种危及生命的疾病，我们在血液透析患者中使用 DPP-4I 时应谨慎，因为他们的免疫系统可能受损。
Bullous pemphigoid (BP) is the most common autoimmune subepidermal bullous diseases. Autoantibodies against hemidesmosomal adhesion proteins might be involved in the developing process. BP usually affects the elderly with high mortality whereas the drug-induced BP is often improved and rarely relapses after the withdrawal of the suspected drug. An accumulated evidence suggests that dipeptidyl peptidase-4 inhibitor (DPP-4I), which has been widely used as the antidiabetic drug improves glycemic control with little risk for hypoglycemia, could be an inducer of DPP-4I-associated BP (DPP-4I-BP). While the precise mechanism remains unclear, a unique immunological profile with human leukocyte antigen (HLA)-DQB1*03:01 could be a biomarker of genetic susceptibility to DPP-4I-BP. Here, we encountered an interesting case of DPP-4I-BP with HLA-DQB1*03:01, which was likely triggered by scabies. A 56-year-old Japanese male with type 2 diabetes on hemodialysis was referred to our hospital due to worsened blisters. Prior to his admission, he had been on linagliptin, a DPP-4I, for 5 months. He then suffered from scabies 2 weeks before his admission while the treatment with ivermectin failed to improve his symptom. Based on his clinical symptom, positive for anti-BP180 autoantibody in serum, and the pathological alterations of skin biopsy specimens, he was diagnosed with DPP-4I-BP. Importantly, he also carried an HLA-DQB1*03:01 allele. Oral prednisolone was subsequently administered after the discontinuation of linagliptin, and his symptom gradually disappeared. Given the fact that the DPP-4I-BP could be a life-threating disease, we should be cautious of prescribing DPP-4I in hemodialysis patients, whose immune system could be impaired.