GLIPTIN ASSOCIATED BULLOUS PEMPHIGOID: REPORT OF A CASE DUE TO LINAGLIPTIN

Bullous pemphigoid is an autoimmune bullous disease, which most commonly affects elderly female. In recent times, this clinical entity is resembled by a cutaneous adverse drug reaction which is caused by DPP4 inhibitors, Gliptins. The DPP4 inhibitors has become a favourite among the diabetologists because it has got no hypo-glycemic risk. The reported case was a 53-year-old lady who had long-term type II diabetes mellitus and was switched over to Linagliptin 5mg once daily 7 months before the onset of the skin lesions. WHO UMC causality-assessment scale and Naranjo scale showed a “probable” causality of the drug; Modied Schumock and Thornton scale to assess the preventability showed it to be “not preventable”. Hartwig's severity assessment scale showed that the reaction was moderately severe (Level 3). Histopathology revealed subepidermal spilt with peri-vascular mixed inammatory inltrate. The paucity of eosinophils in the biopsy was a pointer against the “classical autoimmune bullous pemphigoid” another favoured the differential diagnosis of GABP. Linagliptin was stopped and gliozin (SGLT2 inhibitor) was started along with Azathioprine to control the severity of the disease. Bullae disappeared by 5 weeks and did not recur even after stoppage of azathioprine. The present case is an eye-opener to the fact that an apparently safe drug can precipitate a skin disorder that can incapacitate a person in professional and personal life.