Intravenous Immunoglobulin for the Treatment of Quetiapin-Induced Bullous Pemph...

• Author(s): Cabete, J ; Santos, G ; Páris, F ; Serrão, V ; Fidalgo, A
• Date: 2013
• Persistent ID: http://hdl.handle.net/10400.17/1655
• Origin: Repositório do Centro Hospitalar de Lisboa Central, EPE
• Subject(s): HSAC DER; HIV; Imunoglobulinas Intravenosas; Penfigoide Bolhoso
• Document Type: Other
• Language: English

Description

The authors present the case of a 48-year-old woman with HIV-­associated dementia treated with antiretroviral therapy and psychoactive drugs, to whom bullous pemphigoid(BP) was diagnosed. Given incomplete response to corticotherapy, and azathioprine-­induced bicytopenia,intravenous immunoglobulin(IVIG) was initiated. Despite transient disease control, recurrent flares suggested a persistent triggering factor. Specifically, quetiapin was implicated and discontinued with an immediate clinical response. Inadvertent re-­challenge with olanzapine(a related drug)led to a new eruption, confirming drug-­induced BP (DIBP). A total of six IVIG cycles were completed, without severe side effects to report, namely HIV disease progression. HIV-­related autoimmune bullous diseases are rare. Treatment of severe drug eruptions is primarily based on immunossupressive drugs, raising concerns regarding additional immunossupression. This case suggests IVIG as a valuable option for the treatment of BP in HIV patients. In addition, quetiapin should be added to the list of neuroleptics previously linked to DIBP.