Semaglutide induced bullous pemphigoid

Bullous pemphigoid (BP) is an autoimmune disease that is characterized by autoantibodies attacking molecules of the basement membrane that result in destruction of dermal-epidermal connection. BP occurs either idiopathic or secondary to underlying causes such as radiation therapy, exposure to chemical irritants and medications. We present a case of a 68-year-old woman who presented with 3-week history of itchy rash that evolved over time into multiple tense, fluid-filled blisters. The patient had multiple comorbid conditions including type 2 diabetes mellitus and end-stage renal disease, and was on dialysis. She was prescribed semaglutide 4 months prior to initial presentation, for tighter diabetes control. Skin biopsy showed eosinophilic infiltrate in dermal papillae with micro-abscesses. The patient was diagnosed with bullous pemphigoid secondary to semaglutide use. This case highlights the association between semaglutide and BP, and the importance of suspecting BP in patients who take semaglutide. • This case report demonstrates the need of recognizing rare side effects of semaglutide and consider semaglutide as a possible trigger of bullous pemphigoid. • Early recognition, diagnosis and management of bullous pemphigoid is crucial to avoid treatment delays and complications • Discontinuing semaglutide and administrating steroids and doxycycline is the cornerstone for treatment of bullous pemphigoid. • As the use of GLP-1 agonist increases not only in diabetes but also obesity management, we may see more adverse reactions reported and clinicians should be familiar with these reactions. Our case highlights a rare, yet significant dermatological adverse effect associated with Semaglutide use, presenting as bullous pemphigoid in a patient with type 2 diabetes mellites. Give the increasing use of GLP-1 receptor agonists in the treatment of obesity and diabetes recognizing this potential complication is crucial for timely diagnosis and treatment. We believe our findings will contribute valuable insights to clinicians managing such patients and may prompt further research into the underlying immunological mechanisms underlying this reaction.