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Case Reports: Adverse drug reactions and complications
Two cases of linagliptin-associated bullous pemphigoid resulting in sepsis and endocarditis
  1. Michael Vanner1,
  2. Alexander Tanner2 and
  3. Ali Chakera3
  1. 1Medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
  2. 2University Hospitals Sussex NHS Foundation Trust, Brighton, UK
  3. 3Royal Sussex County Hospital, Brighton, UK
  1. Correspondence to Dr Michael Vanner; michael.vanner2{at}nhs.net

Abstract

We describe two patients, in their 70s, each presenting to the emergency department, with 6-week histories of progressively developing pruritic bullae. Both individuals had multiple comorbidities, including type 2 diabetes—for which they took linagliptin, chronic kidney disease, hypertension and prosthetic heart valves. Owing to systemic illness and endocarditis secondary to superadded bacterial infections, they both required intensive treatment and prolonged hospital admissions.

Despite the beneficial effect of linagliptin on glycaemic control and its reported cardiovascular and renal safety profiles, we add our cases as evidence of the significant risk of developing bullous pemphigoid while taking this medication. Secondary infection of bullous pemphigoid increased the risk of developing endocarditis, particularly among individuals with a medical history of valve replacement surgery. Considering this, we advocate caution when prescribing this medication.

  • Dermatology
  • Diabetes
  • Infectious diseases
  • Unwanted effects / adverse reactions

https://doi.org/10.1136/bcr-2023-255358

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: supervised by AC. Patients were under the care of AC. Report was written by MPV, AT and AC. The following authors gave final approval of the manuscript: MPV, AT and AC.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.