Valsartan Induced Bullous Pemphigoid in a Young Adult: Clinical and Immunopathological Insights
K. Diaa *
Department of Dermatology-Venereology, Mohammed V University, Ibn Sina University Hospital, Rabat, Morocco.
R. Boufettama
Department of Dermatology-Venereology, Mohammed V University, Ibn Sina University Hospital, Rabat, Morocco.
S. Hamada
Department of Dermatology-Venereology, Mohammed V University, Ibn Sina University Hospital, Rabat, Morocco.
M. Meziane
Department of Dermatology-Venereology, Mohammed V University, Ibn Sina University Hospital, Rabat, Morocco.
N. Ismaili
Department of Dermatology-Venereology, Mohammed V University, Ibn Sina University Hospital, Rabat, Morocco.
L. Benzekri
Department of Dermatology-Venereology, Mohammed V University, Ibn Sina University Hospital, Rabat, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Background: Bullous pemphigoid (BP) is an autoimmune blistering disorder that predominantly affects the elderly population. Although its exact pathophysiology remains incompletely understood, a strong link to pharmacological agents has been well established. Herein, we report a rare case of valsartan-induced bullous pemphigoid in a young female patient.
Presentation of Case: A 40-year-old female presented to the emergency department with a widespread cutaneous eruption associated with severe pruritus. Anamnesis revealed recent initiation of an angiotensin II receptor blocker for newly diagnosed hypertension. Clinical examination demonstrated multiple urticarial plaques with polycyclic borders, surmounted by numerous tense bullae, alongside widespread post-bullous erosions involving the entire body, with genital mucosal involvement. Skin biopsy with direct and indirect immunofluorescence was consistent with bullous pemphigoid. The antihypertensive agent was discontinued. Systemic therapy with oral prednisone was initiated and gradually tapered. The clinical outcome was favourable, showing marked disease improvement with complete re-epithelialisation of the lesions.
Discussion: Drug-induced bullous pemphigoid is a variant triggered by a wide array of medications. It is distinguished from the idiopathic form by an earlier age of onset, unusually frequent mucosal involvement, clinical resolution following the withdrawal of the culprit drug, and marked peripheral blood hypereosinophilia. The identification and prompt discontinuation of the offending molecule are imperative, particularly in severe, life-threatening presentations.
Conclusion: Bullous pemphigoid can occasionally manifest as an adverse drug reaction following the initiation of various medications, including antihypertensive therapies. The identification and immediate discontinuation of the offending drug are imperative, taking into account the risk-benefit ratio.
Keywords: Bullous pemphigoid, valsartan, drug-induced, hypereosinophilia, adverse drug reaction