Lisinopril Associated with Non-Pemphigus Bullae Lesions

Abstract Background: Angiotensin-converting enzyme inhibitors are first-line drugs for patients suffering from hypertension. These drugs have common adverse effects including bronchospasm, cough, and angioedema. Drug-induced bullous eruptions have been reported previously with numerous drugs including lisinopril, an angiotensin-converting enzyme inhibitor. Three patients of note have had a form of biopsy-proven pemphigus induced by the introduction of lisinopril or an increase in dosage. We report a case of lisinopril-induced bullae that is not pemphigus foliaceus or bullous pemphigoid verified by biopsy.Case Presentation: A 65-year-old male presented with a blistering rash over his left flank, belly button and with a cluster on his ankle. His medical history is significant for hypertension, which was controlled by 20mg of lisinopril, which had been increased to 40mg in order to provide better control. A skin biopsy was done on one of the rashes with a histological report of a bullous reaction with a low possibility of bullous pemphigoid and probably caused by arthropod bite or drug hypersensitivity. Within a month of dosage change the patient started developing bullae across his body, with no relief from oral steroid administration. The patient was taken off lisinopril and within days the bullae started to heal and there were no new eruptions. Conclusion: Pemphigus is an autoimmune condition that causes blistering of the skin and mucous membranes and can be triggered by the environment, genetics or vaccination. Three patients have been reported to have a biopsy-proven pemphigus reaction caused by the introduction of lisinopril or an increase in dosage. These blisters were classified as pemphigus after biopsy and pathological analysis. These cases were resolved with removal of the medication from their regime along with topical creams to aid in healing. There is no known study published of a lisinopril-induced non-pemphigus bullae which our patient presented with after the doubling of his lisinopril dose and a pathology report stating a low likelihood of bullous pemphigoid.