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Treatment for syphilis unraveling gluten-sensitive linear IgA dermatosis

Linear IgA bullous dermatosis (LAD) is an acquired autoimmune blistering disorder which can develop following various drugs but not after banzathine penicillin injection. LAD has lower prevalence of associated gluten-sensitive enteropathy (GSE). We describe the case of a 20-year-old male with homosexual behavior who presented with multiple pruritic maculopapular lesions over the trunk, extremities, and palms for 2 months. Rapid plasma reagin (1:1280 titer) and treponema pallidum hemeagglutination tests were positive. A diagnosis of syphilis was made. The patient developed vesicular lesions following benzathine penicillin injection with histopathological and immunofluorescent features characteristic of LAD. Despite treatment, the patient continued developing new vesicles. Gluten-free diet (GFD) was advised, and the patient was further investigated for GSE. The patient responded well to GFD. We conclude that the prevalence of drug-induced LAD and associated GSE is quite low, but possibility exists. Hence, a diagnosis of GSE must be sought as patients might respond to GFD.