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Drug-Induced Pemphigus — SCE Dermatology MCQ

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ModerateDrug ReactionsDrug-Induced PemphigusSCE Dermatology

A 40-year-old woman develops painful oral erosions and a widespread blistering eruption 3 weeks after starting Penicillamine for Wilson disease. DIF shows intercellular IgG. Anti-desmoglein antibodies are positive. What is the most likely diagnosis?

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Correct answer: D — Drug-induced pemphigus

Drug-induced pemphigus can present identically to idiopathic pemphigus with intercellular IgG and positive anti-desmoglein antibodies. Penicillamine is the classic causative agent (thiol-containing drug), along with Captopril, Enalapril, and Bucillamine. Drug-induced pemphigus may present as PV or PF type. The key distinction from idiopathic pemphigus is the temporal relationship with drug initiation and potential resolution after drug withdrawal (though this may take months). The causative drug should be stopped. Some cases require immunosuppressive treatment identical to idiopathic PV if disease persists after withdrawal.

Reference: BAD 2017 Pemphigus Guidelines; BJD Drug-induced Pemphigus