PMID- 31993957
OWN - NLM
STAT- MEDLINE
DCOM- 20210831
LR  - 20210831
IS  - 2192-4449 (Electronic)
IS  - 2192-4449 (Linking)
VI  - 9
IP  - 3
DP  - 2020 Aug
TI  - Dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid, likely triggered 
      by scabies, in a hemodialysis patient with human leukocyte antigen-DQB1*03:01.
PG  - 189-194
LID - 10.1007/s13730-020-00452-2 [doi]
AB  - 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.
FAU - Hibi, Arata
AU  - Hibi A
AUID- ORCID: 0000-0002-5941-5679
AD  - Department of Nephrology and Rheumatology, Rakuwakai Otowa Hospital, 2, Otowa 
      Chinji-cho, Yamashina-ku, Kyoto, 607-8062, Japan. exchange1113@yahoo.co.jp.
FAU - Kasahara, Yuto
AU  - Kasahara Y
AD  - Department of Nephrology and Rheumatology, Rakuwakai Otowa Hospital, 2, Otowa 
      Chinji-cho, Yamashina-ku, Kyoto, 607-8062, Japan.
FAU - Ishihara, Yoshitaka
AU  - Ishihara Y
AD  - Department of Nephrology and Rheumatology, Rakuwakai Otowa Hospital, 2, Otowa 
      Chinji-cho, Yamashina-ku, Kyoto, 607-8062, Japan.
FAU - Hata, Koichi
AU  - Hata K
AD  - Department of Nephrology and Rheumatology, Rakuwakai Otowa Hospital, 2, Otowa 
      Chinji-cho, Yamashina-ku, Kyoto, 607-8062, Japan.
FAU - Hosokawa, Norihisa
AU  - Hosokawa N
AD  - Department of Nephrology and Rheumatology, Rakuwakai Otowa Hospital, 2, Otowa 
      Chinji-cho, Yamashina-ku, Kyoto, 607-8062, Japan.
FAU - Nakagawa, Takahiko
AU  - Nakagawa T
AD  - Department of Nephrology and Rheumatology, Rakuwakai Otowa Hospital, 2, Otowa 
      Chinji-cho, Yamashina-ku, Kyoto, 607-8062, Japan.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20200128
PL  - Japan
TA  - CEN Case Rep
JT  - CEN case reports
JID - 101636244
RN  - 0 (Autoantibodies)
RN  - 0 (Dipeptidyl-Peptidase IV Inhibitors)
RN  - 0 (Glucocorticoids)
RN  - 0 (HLA-DQ beta-Chains)
RN  - 0 (HLA-DQB1 antigen)
RN  - 3X29ZEJ4R2 (Linagliptin)
RN  - 9PHQ9Y1OLM (Prednisolone)
SB  - IM
MH  - Alleles
MH  - Autoantibodies/immunology
MH  - Biopsy/methods
MH  - Diabetes Mellitus, Type 2/drug therapy
MH  - Dipeptidyl-Peptidase IV Inhibitors/*adverse effects/therapeutic use
MH  - Glucocorticoids/administration & dosage/therapeutic use
MH  - HLA-DQ beta-Chains/genetics/immunology
MH  - Humans
MH  - Linagliptin/*adverse effects/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Pemphigoid, Bullous/*chemically induced/genetics/immunology/pathology
MH  - Prednisolone/administration & dosage/therapeutic use
MH  - Renal Dialysis/methods
MH  - Scabies/*complications
MH  - Treatment Outcome
PMC - PMC7320129
OTO - NOTNLM
OT  - Bullous pemphigoid
OT  - Diabetes
OT  - Dipeptidyl peptidase-4 inhibitor
OT  - Human leukocyte antigen-DQB1*03:01
OT  - Scabies
COIS- The authors declare no conflict of interests associated with this manuscript.
EDAT- 2020/01/30 06:00
MHDA- 2021/09/01 06:00
PMCR- 2020/01/28
CRDT- 2020/01/30 06:00
PHST- 2019/11/06 00:00 [received]
PHST- 2020/01/18 00:00 [accepted]
PHST- 2020/01/30 06:00 [pubmed]
PHST- 2021/09/01 06:00 [medline]
PHST- 2020/01/30 06:00 [entrez]
PHST- 2020/01/28 00:00 [pmc-release]
AID - 10.1007/s13730-020-00452-2 [pii]
AID - 452 [pii]
AID - 10.1007/s13730-020-00452-2 [doi]
PST - ppublish
SO  - CEN Case Rep. 2020 Aug;9(3):189-194. doi: 10.1007/s13730-020-00452-2. Epub 2020 
      Jan 28.