Abstract

Pemphigus foliaceus, a rare autoimmune condition, is one among several entities that make up a group of life threatening blistering disorders called pemphigus. It is distinguished by isolated cutaneous involvement and subcorneal acantholytic blisters. 1 This case demonstrates a possible relationship between the drug tirzepatide and pemphigus foliaceus.

A 63-year-old female, with a past medical history of type 2 diabetes mellitus, arthritis, skin cancer, and uterine cancer, presented with arthralgias and diffuse, blistering ulceration 1-2 days after initiating tirzepatide for type 2 diabetes. Patient’s symptoms began with severe joint pain in her right carpometacarpal joint, which then migrated to her left index finger distal interphalangeal joint. She then noticed small, white lesions on her elbows that developed into white, tense blisters within a couple days. These lesions spread down both of her arms, legs, and feet. She also had 2-3 remote lesions below her breast. She took tirzepatide again, a week after the initial dose, and noticed worsening of her symptoms. She had associated mild fever, chills, and appetite changes. She presented to the hospital and was found to have overlying cellulitis of her wounds. She underwent debridement of her hands and feet and a 3 week course of vancomycin and cefepime. Biopsies of the lesions were consistent with pemphigus foliaceous. She was started on a steroid taper after which she experienced significant improvement of her lesions.

Drugs are the most common trigger of pemphigus. 2 Tirzepatide is a relatively new drug with no known case reports of associated pemphigus foliaceus. Given the temporal relationship of starting tirzepatide with the onset of lesions, and worsening of symptoms with repeat administration of the drug, this case could be the first to establish an association between tirzepatide and pemphigus foliaceus.

Accepted to 9th Annual BUMC Medical Education Research Forum 2023

Citations

1. Hertl M, Sitaru C. Pathogenesis, clinical manifestations, and diagnosis of pemphigus. Pathogenesis, clinical manifestations, and diagnosis of pemphigus. UptoDate. https://www.uptodate.com/contents/pathogenesis-clinical-manifestations-and-diagnosis-of-pe mphigus. Published September 14, 2022. Accessed February 13, 2023.

2. Tavakolpour S. Pemphigus trigger factors: special focus on pemphigus vulgaris and pemphigus foliaceus. Arch Dermatol Res. 2018;310(2):95-106. doi:10.1007/s00403-017-1790-8