Vildagliptin Induced Bullous Vasculitis: A Case Report with Causality Assessment
Saagarika Pandith *
Department of Pharmacy Practice, PES University, Bangalore, Karnataka, India.
Nagaraja Eranna
Department of Dermatology, PESU Institute of Medical Sciences & Research (PESUIMSR), Bangalore, Karnataka 560100, India.
*Author to whom correspondence should be addressed.
Abstract
Bullous vasculitis is a rare form of cutaneous small-vessel vasculitis characterized by blistering over inflamed skin. We report a 42-year-old woman with type 2 diabetes mellitus who had been on a vildagliptin-based oral antidiabetic regimen for six months. After discontinuing the medication on her own, 6 months after she developed bilateral lower limb swelling with painful ulcerations and bullae, which persisted in the setting of poor glycemic control. During hospitalization, rechallenge with vildagliptin led to a clear worsening of the lesions. The drug was subsequently withdrawn, following which gradual clinical improvement was observed. Histopathological findings were consistent with bullous leukocytoclastic vasculitis. Discontinuation of vildagliptin along with initiation of insulin therapy resulted in progressive healing of the ulcers. Causality assessment using the Naranjo Adverse Drug Reaction Probability Scale suggested a probable association. This case highlights the importance of recognizing drug-related cutaneous.
Keywords: Vildagliptin, bullous leukocytoclastic vasculitis, dipeptidyl peptidase-4 inhibitors, drug-induced vasculitis, adverse drug reaction