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Drug eruption due to prasugrel hydrochloride: A case report and mini‐review

domain, desmoglein-1 and desmoglein-3 were not detected using ELISA. Histopathological examination of a biopsy specimen from his forearm showed subepidermal blisters containing eosinophils and neutrophils, and superficial perivascular infiltration of eosinophils and neutrophils in the dermis (Fig. 1b,c). Direct immunofluorescence (IF) showed linear deposits of complement C3 and immunoglobulin G (IgG) on the basement membrane zone (BMZ; Fig. 1d). Indirect IF of normal human skin showed IgG anti-BMZ antibodies at low titer. Indirect IF of 1 mol/L NaCl-split skin showed the IgG reactivity with the dermal side (Fig. 1e). We ceased corticosteroids and treated him with ivermectin. We administrated ivermectin again when he came 2 weeks later. Five weeks later, the bullae and erosions were all epithelialized only with ivermectin. No recurrence has been observed. The immunoblotting of normal human dermal extract showed that IgG antibodies in our patient’s serum reacted with a 200kDa protein, with which control anti-laminin-c1 pemphigoid serum also reacted (Fig. 1f). We finally diagnosed him with bullous scabies (BS) associated with anti-laminin c1 pemphigoid. Bullous scabies is a rare subtype of scabies showing bullous lesions. It is often difficult to distinguish BS from BP, which causes the delay of diagnosis. Autoantibodies and autoantigens in BS are unclear. Forty-four cases of BS have been reported until 2016. Among them, 18 of 32 cases were positive in direct IF and five of 29 cases were positive in indirect IF. Dermatologists should quickly make a diagnosis of BS to prevent outbreaks of scabies. In the English-language published work, to our knowledge, there are only three BS cases in which autoantigens were identified. Case 1 showed IgG autoantibodies against BP180, and case 2 showed IgG antibodies against BP180 and BP230. The cessation of prednisolone resulted in the recurrence of blisters, indicating that scabies might have induced real BP in these cases. In case 3, autoantibodies against laminin-c1 was identified, and the remission was achieved with oral prednisolone 30 mg/day. The treatment with prednisolone was stopped without any recurrence. In the present case 4, the treatment with only ivermectin improved bullous lesions. Whereas symptoms in cases 1 and 2 were continuous, those in cases 3 and 4 were transient. These findings may suggest that symptoms in BS patients with anti-BP 180 autoantibodies are more persistent than those in BS patients with anti-laminin c1 antibodies in BS patients. The response to the treatments may differ depending on the types of autoantibodies.