A case of bullous pemphigoid and renal disease after dipeptidyl peptidase 4 inhibitor administration

Atsuhiko Suenaga; Naoki Sawa; Yuki Oba; Daisuke Ikuma; Akinari Sekine; Masayuki Yamanouchi; Eiko Hasegawa; Hiroki Mizuno; Tatsuya Suwabe; Nobukazu Hayashi; Kei Kono; Keiichi Kinowaki; Kenichi Ohashi; Motoaki Miyazono; Yutaka Yamaguchi; Yoshifumi Ubara

doi:10.1007/s13730-023-00835-1

A case of bullous pemphigoid and renal disease after dipeptidyl peptidase 4 inhibitor administration

CEN Case Rep. 2023 Dec 6. doi: 10.1007/s13730-023-00835-1. Online ahead of print.

Authors

Atsuhiko Suenaga^{1

2}, Naoki Sawa^{3

4}, Yuki Oba³, Daisuke Ikuma³, Akinari Sekine⁵, Masayuki Yamanouchi³, Eiko Hasegawa^{5

4}, Hiroki Mizuno³, Tatsuya Suwabe³, Nobukazu Hayashi⁶, Kei Kono⁷, Keiichi Kinowaki⁷, Kenichi Ohashi^{7

8}, Motoaki Miyazono⁹, Yutaka Yamaguchi¹⁰, Yoshifumi Ubara^{3

4}

Affiliations

¹ Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan. atsuhiko4822gh@gmail.com.
² Department of Nephrology, Saga University Internal Medicine, Saga, Japan. atsuhiko4822gh@gmail.com.
³ Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
⁴ Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
⁵ Department of Nephrology and Rheumatology, Toranomon Hospital, Tokyo, Japan.
⁶ Department of Dermatology, Toranomon Hospital, Tokyo, Japan.
⁷ Department of Pathology, Toranomon Hospital, Tokyo, Japan.
⁸ Department of Human Pathology, Tokyo Medical Dental University, Tokyo, Japan.
⁹ Department of Nephrology, Saga University Internal Medicine, Saga, Japan.
¹⁰ Yamaguchi's Pathology Laboratory, Chiba, Japan.

PMID: 38055184
DOI: 10.1007/s13730-023-00835-1

Abstract

A 62-year-old man with type 2 diabetes was admitted because of a decrease in estimated glomerular filtration rate from 72 to 17.5 mL/min/1.73 m² in 10 years and development of widespread bullous skin lesions. His hemoglobin A1c level had been maintained at 6.0-7.0% for 10 years with a dipeptidyl peptidase (DPP)-4 inhibitor. Skin biopsy showed typical bullous pemphigoid, and kidney biopsy showed tubulointerstitial nephritis with eosinophilic infiltration and glomerular endothelial cell proliferation. After discontinuing the DPP-4 inhibitor, skin lesions improved, and renal decline slowed. This case indicates that DPP-4 inhibitors can cause not only skin lesions but also renal disease.

Keywords: Bullous pemphigoid; Diabetic nephropathy; Dipeptidyl peptidase-4 inhibitor; Glomerular endothelial cell injury.