Intravenous Immunoglobulin for the Treatment of Quetiapin-Induced Bullous Pemphigoid in an HIV-Infected Patient

摘要

The authors present the case of a 48-year-oldwoman with HIV-­associated dementia treatedwith antiretroviral therapy and psychoactivedrugs, to whom bullous pemphigoid(BP) wasdiagnosed. Given incomplete response tocorticotherapy, and azathioprine-­inducedbicytopenia,intravenous immunoglobulin(IVIG)was initiated. Despite transient diseasecontrol, recurrent flares suggested apersistent triggering factor.Specifically, quetiapin was implicated anddiscontinued with an immediate clinicalresponse. Inadvertent re-­challenge witholanzapine(a related drug)led to a neweruption, confirming drug-­induced BP(DIBP). A total of six IVIG cycles werecompleted, without severe side effectsto report, namely HIV disease progression.HIV-­related autoimmune bullous diseases arerare. Treatment of severe drug eruptionsis primarily based on immunossupressive drugs, raising concerns regarding additionalimmunossupression. This case suggests IVIGas a valuable option for the treatment of BPin HIV patients. In addition, quetiapinshould be added to the list of neurolepticspreviously linked to DIBP.