J Korean Med Sci.  2006 Jun;21(3):585-587. 10.3346/jkms.2006.21.3.585.

Bucillamine-Induced Pemphigus Vulgaris in a Patient with Rheumatoid Arthritis and Polymyositis Overlap Syndrome

• Hur JW
• Lee CW
• Yoo DH

• KMID: 1778451
• DOI: http://doi.org/10.3346/jkms.2006.21.3.585

Abstract

Bucillamine is a disease modifying anti-rheumatic drug, structurally similar to D-penicillamine. Although D-penicillamine-induced pemphigus has been not infrequently demonstrated, pemphigus associated with bucillamine was rarely reported. We describe a patient complicating pemphigus vulgaris after bucillamine treatment in rheumatoid arthritis (RA) and polymyositis (PM) overlap syndrome. PM and RA overlap syndrome was diagnosed three years ago and bucillamine was administrated for 20 months. Skin lesions including erythematous flaccid blisters on her chest, axillae, and back were occurred and were compatible with pemphigus vulgaris by typical pathology. Withdrawal from bucillamine and prednisolone treatment made rapid improvement of pemphigus lesions.

Keyword

bucillamine; Pemphigus; Polymyositis; Arthritis, Rheumatoid; adverse effects

MeSH Terms

Syndrome
Skin/pathology
Polymyositis/*complications/*drug therapy
Pemphigus/*chemically induced/*pathology
Middle Aged
Humans
Female
Cysteine/adverse effects/*analogs & derivatives
Biopsy
Arthritis, Rheumatoid/*complications/*drug therapy
Arthritis
Antioxidants/*adverse effects

Figure

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  Fig. 1 Erythematous patches and superficial erosions with pustular bullae on axillae and back of the patient.

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  Fig. 2 Skin biopsy shows acantholysis at the suprabasal layer, as well as at the upper layers of epidermis (H&E, ×400).

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