Reactions 1046 - 9 Apr 2005

★Atenolol/imidapril

Pemphigus (first report with imidapril) and atenolol-induced lupus in an elderly patient: case report

A 67-year-old woman developed lupus during treatmentwith atenolol, and later developed pemphigus duringtreatment with imidapril for hypertension.

The woman presented with a 1-year history ofphotodistributed telangiectatic erythema, ragged posteriorcuticles and periungual erythema. Laboratory investigationsrevealed positive antinuclear, anti-dsDNA and antihistoneantibodies, consistent with drug-induced lupus. Severalmonths prior to the onset of her symptoms, she had startedtreatment with atenolol [dosage not stated].

Atenolol was discontinued and, after 3 months, thewoman’s skin eruption had resolved and her autoantibodylevels had normalised. Almost 5 years later, 2.5 years afterstarting treatment with imidapril [dosage not stated], shedeveloped crusted plaques and erosions over her scalp, armsand upper back. Examination, histology andimmunofluorescence were consistent with pemphigusfoliaceus. Treatment with prednisolone andhydroxychloroquine was started and imidapril wasdiscontinued; 4 months later, her skin eruption had improvedsignificantly. Subsequent HLA typing revealed HLA-DR4.

Author comment: "At this point we can only surmise thatthe haplotype HLA-DR4 predisposes to a unique drugmetabolism that results in the development of these two raredrug-induced immune-mediated dermatoses."Ah-Weng A, et al. A case report of drug-induced pemphigus foliaceus preceded bya history of drug-induced lupus erythematosus. Journal of the American Academyof Dermatology 52 (Abstr. Suppl.): 42, No. 3, Mar 2005 [abstract + poster] -England 801005268

» Editorial comment: A search of AdisBase, Medline and theWHO Adverse Drug Reactions database did not reveal anyprevious case reports of pemphigus associated with imidapril.

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Reactions 9 Apr 2005 No. 10460114-9954/10/1046-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved