Serviço de Dermatologia do Hospital dos Capuchos, Centro Hospitalar de Lisboa Central, EPE
Abstract
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