Case of bullous pemphigoid induced by apatinib mesylate

Bullous pemphigoid (BP) is a kind of immune bullous disease that often occurs in the elderly. Skin lesions manifest as pruritus papules or urticaria-like rash, accompanied by tension bullae. Immunopathology showed linear deposition C3 and IgG epidermal basement membrane, anti-IgG autoantibodies serum. The mechanism BP interaction between antigens (BP180/collagen XVII BP230) hemidesmosomes basal keratinocytes.1 Current treatments include topical systemic use glucocorticoids other immunosuppressants. According to relevant reports, penicillin,2 captopril,3 teneliglipten,4 metamizole,5 erlotinib6 can all cause drug-induced (DIBP). However, no reports apatinib mesylate inducing have been published. Herein, we present case DIBP triggered oral whose diagnosis was clinically histopathologically confirmed. A 62-year-old Chinese woman presented with 2-week history flaky erythema multiple blisters accompanying mucosa be affected admitted our hospital. In 2007, patient diagnosed malignant breast tumour underwent surgical treatment. From January 2019, she began take megesterone acetate dispersible tablets (H20010074, 160 mg orally each day) (H20140103, 0.5 g for treatment tumour. Two weeks before presentation, left neck chest patchy itching. Ten days later, it had spread neck, trunk, upper limbs bilateral groins, severe itching local bullae, erosion pain mucosa, pharynx cough (Figure S1a–b). An initial dermatitis medicamentosa made, while discontinuation antiallergic medication ineffective. Physical examination revealed scattered erosive surfaces buccal palate, massive oedematous some which were targetoid shape. Tensive bullae locally visible, filled yellowish fluid, Nikolsky sign negative. skin biopsy from forearm subepidermal blister S2). Negative results obtained both direct indirect immunofluorescence. Enzyme linked immunosorbent assay test BP180 antibody 84.3 U/mL (normal range, < 20 U/mL), desmin 1/3 BP230 normal. Since immunofluorescence negative, performed another immunohistochemical positive7 1). made based on above clinical signs examinations. targeted drug discontinued cured after 14 methylprednisolone 60 mg/d intravenous drip Oral prednisone (25 daily) started. All resolved 2 months relapse over 5-month follow-up observed. No recurrence found follow-up. Apatinib tablets, an vascular endothelial growth factor receptor-2 (VEGFR-2) inhibitor, has approved advanced gastric adenocarcinoma gastric–oesophageal junction patients failure second-line therapy. addition, studies shown good antitumour activity against solid tumours. Commonly reported side effects leukopenia, granulocytopenia, thrombocytopenia, proteinuria, hypertension, fatigue, hoarseness. Hand–foot syndrome (palms, plantar redness at tip fingers) most common reaction taking medicine. not common, first 1970 11-year-old boy receiving salicylazosulphapyridine.8 Currently, 50 drugs9 induce BP, including antibiotics, antiarrythmics, antihypertensives, vaccines, nonsteroidal anti-inflammatory drugs, salicylates diuretics. systematic summary following characteristics are found: younger age onset, positive sign, appearance normally appearing skin, involvement lower leg areas, target palms soles, mucosal involvement, marked eosinophilic infiltrate, intraepidermal vesicles, necrotic keratinocytes, thrombus formation, eosinophilia (serum), improvement administration corticosteroids, specific drug, low rates recurrence.10 To knowledge, this report apatinib-induced BP. case, middle-aged damage rash extended limbs. therapeutic effect methylprednil significant. We conducted antihistamine according eruption poor efficacy. After biopsy, laboratory immunohistochemical, confirmed, rashes significantly improved do know sure whether associated disorders caused future, number drugs thought likely increase new antineoplastic develop. Three-year action plan (ZY(2018–2020)-ZYBZ-38). There competing interests declare. Y.M. F.S. treated patient. Q.W. X.S. analysed results. W.J. searched literature. Q.Z. S.X. wrote manuscript. FIGURE S1a Supporting Information S1b S2 Please note: publisher responsible content functionality any supporting information supplied authors. Any queries (other than missing content) should directed corresponding author article.