Abstract

GENERALIZED BLISTER DRUG ERUPTION IN A PATIENT WITH DIABETES MELLITUS RECEIVING A COMBINATION OF SODIUMGLUCOSE TRANSPORT PROTEIN 2 INHIBITOR AND DIPEPTIDYL PEPTIDASE-4 INHIBITOR

Lancy Morries*, Dr. Philip Finny, Dr. Jibily Joy and Anjitha Roy

Abstract

Sodium-glucose-transport-protein-2-inhibitors and incretin-based therapies are relatively more recently recommended medication for Diabetes-mellitus. The cutaneous adverse-effects reported by these drugs are to be kept in mind. A 52-year-old gentleman with Type 2 diabetes-mellitus presented to the Endocrinology department of a tertiary care hospital nearby with a history of osmotic symptoms suggestive of uncontrolled Diabetes. He had been previously treated with a fixed dose combination of metformin/glimepiride as well as insulin. However, the sugars were uncontrolled and the HbA1c was 7.9%. The endocrinologist added a combination tablet of empagliflozin/linagliptin (Glyxambi). On the third day of this treatment, he developed blisterlike- eruptions on his limbs, mouth and throat which gradually became infected. Consequently, this new drug was immediately discontinued and the patient was treated with oral Prednisolone and Amoxicillin and gradually the blisters improved. Based on the patient's clinical course, the drug-eruption was suspected to be caused most likely by either Linagliptin or Empagliflozin. Empagliflozin can rarely cause such dermatological side effects but these have not been described with Linagliptin. In this patient, who was given the combination of the above two medications, it is difficult to pinpoint the exact culprit. However, the SGLT-2 inhibitor is the more likely cause. In the current scenario where combinations of SGLT-2 inhibitors and DPP-4 inhibitors are being increasingly prescribed, the possibility of these cutaneous adverse-effects should be considered. Thus this case report highlights an unreported adverse-effect of linagliptin/empagliflozin combination.

Keywords: Diabetes mellitus, Empagliflozin, blister-like eruptions, SGLT2 inhibitor, drug reaction.