P130 - VEDOLIZUMAB-INDUCED BULLOUS PEMPHIGUS IN A PATIENT WITH ULCERATIVE COLITIS
(Room Poster Hall)
19 Jan 18
5:30 PM
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7:00 PM
Tracks:
Clinical and Research Challenges
Bullous Pemphigus (BP) is a common acquired immunobullous disease. PB secondary to exposure to different drugs has been described. Mesalamines, Immunomodulators (Azathioprine, cylosporine), TNF alpha antagonists (Infliximab, Adalimumab and Etanercept), IL12/23 inhibitors (Ustekinumab) have been reported to be associated with PB in the literature. We present a novel case of BP induced by Vedolizumab in a patient with UC. This is a 61 year-old male with a history of long-term pan-ulcerative colitis who was started on vedolizumab after developing lack of response or intolerance to different medications including mesalamines, Adalimumab, Golimumab and Infliximab. Three weeks after Vedolizumab was started, the patient developed diffuse confluent urticarial plaques with overlying erosions and bullae, affecting 50% of body surface area including trunk, extremities, hands, and feet. Skin biopsy revealed a subepidermal blister with undersurface containing neutrophils and scattered eosinophils consistent with autoimmune subepidermal blister disease. Linear IgG and C3 deposition along the membrane zone by direct Immunofluorescence confirmed the diagnosis of BP. BP was treated initially with systemic steroids and the patient was eventually started on Ustekinumab, which resulted in UC and PB clinical remission. TNF-alpha antagonists may cause selective inhibition of a cytotoxic T-lymphocyte response that normally suppresses auto-reactive B cells, resulting in enhanced antibody production and predispose susceptible individuals to develop BP. It was thought that a gut-targeted selective biologic, such as Vedolizumab, would have the potential to reduce systemic side effects. Nevertheless, to our knowledge, this is the first case of Vedolizumab-induced BP in a patient with UC. The mechanism by which Vedolizumab may cause BP remains unclear at this time.