Background: Ocular lesions of pemphigoid include squamous metaplasia of the conjunctival epithelium, loss of goblet cells, and limbal stem cell deficiency. Dipeptidyl peptidase-4 (DPP-4) inhibitors are oral hypoglycemic agents commonly used for treating diabetes. It has been reported that oral DPP-4 inhibitors increase the risk of developing pemphigoid. However, no study has reported ocular symptoms related to DPP-4 inhibitor-related pemphigoid. Here, we report a case of a DPP-4 inhibitor-related pemphigoid with intractable conjunctival lesions.
Case: A 69-year-old male patient visited a local dermatologist with a chief complaint of erosion of the upper limbs, and he was diagnosed with mucosal pemphigoid. Hence, treatment with 5 mg of prednisolone was initiated. The patient had conjunctival hyperemia in both eyes; thus, he visited a local ophthalmologist. As proliferation of membranous substances was observed, the patient was referred to the ophthalmology department at Oita University Hospital for further examination and treatment. During the first visit, the severity of the right and left eyes was classified as the Foster classification stages of II-III and I-II, respectively. A dermatologist at our hospital suspected DPP-4 inhibitor-related pemphigoid, and the patient was admitted to the ophthalmology department of our hospital for further treatment. After admission, DPP-4 inhibitor was discontinued, and the local therapy was started. The patient tested positive for the full-length anti-BP180 antibody, which is a characteristic feature of patients with DPP-4 inhibitor-related pemphigoid. Based on these findings, the patient was diagnosed with a DPP-4 inhibitor-related pemphigoid. After the patient was discharged from the ophthalmology department, he was admitted to the dermatology department of our hospital where he underwent systemic treatment. Gastrointestinal lesions improved. Conjunctival lesions improved in his left eye; however, intractable conjunctival lesions were observed in his right eye. His current visual acuity is 0.04 on the right (n. c.) and 1.0 on the left eye.
Conclusion: We presented a case of a DPP-4 inhibitor-related pemphigoid with refractory conjunctival lesions.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 126: 808-813,2022.