Pemphigus vegetans possible association with enalapril

Introduction
Pemphigus vegetans is the least common form of pemphigus. Typical clinical presentation of the condition involves blisters transforming into papillous or pustular eruptions. Treatment consists of administration of systemic glucocorticosteroids as a monotherapy, or combined with immunosuppressants.

Objective
Presentation of a case of pemphigus vegetans of possible drug-induced aetiology and severe course.

Case Report
A 58-year old man was admitted with papillous lesions persisting for few weeks in the anogenital area, axillae and ear lobes. For several months the man has been using the hypotensive medication – enalapril. Pemphigus vegetans was diagnosed based on the clinical presentation and the immunopathological examination. Enalapril was discontinued and prednisone was introduced at the maximum dose of 2 mg/kg/day, with subsequent improvement of the condition. Considering adverse effects of chronic glucocorticosteroid therapy, azathioprin was also introduced at the dose of 50 mg/day, with gradual reduction of the prednisone dose over time. The patient in good general and local condition remains under supervision of a dermatologist.

Conclusions
A case of a patient is presented with lesions initially suggesting papillary pyroderma. As a result of rapid progression the disease significantly hindered the patient’s everyday functioning. Pemphigus vegetans in this patient may have been induced by enalapril.