Herpetiform pemphigus induced by penicillamine

Abstract

A patient with arthritis is described who developed a dermatitis herpetiformis-like rash after 8 mo. of D-penicillamine therapy and which cleared soon after the drug was discontinued. The histopathological findings were compatible with a diagnosis of pemphigus, showing intra-epidermal vesicles and spongiosis but no acantholysis. Intercellular antibody was detected by indirect immunofluorescence at the onset of the eruption (titer 1 in 160) and also found in serum taken prior to penicillamine treatment (titer 1 in 20). It is well known that D-penicillamine can induce pemphigus. The patient was probably predisposed to develop the eruption before the drug was given.