Steroid-induced diabetes mellitus in pemphigus vulgaris patient at Bali Mandara Hospital: a case report
Keywords:Pemphigus vulgaris, autoimmune, steroid-induced diabetes mellitus
Background: Pemphigus vulgaris (PV) is a blistering autoimmune disease of the skin and mucous membranes defined histologically by intraepidermal blister due to acantholysis. Systemic corticosteroids and immunosuppressive agents had greatly improved the prognosis of pemphigus. However, steroid use often leads to metabolic complications, such as diabetes mellitus. This case report describes steroid-induced diabetes mellitus in PV, where the side effect of long-term high dosages steroid used and the method to manage it can be used as a study case.
Case report: A 31-year-old man complained of new blisters from almost the entire body. He had a history of PV 1 year ago and no history of diabetes mellitus in the patient or family. He had a medication history of methylprednisolone 8 mg every 8 hours. Dermatological status showed erythema macules, extensive erosion almost on the entire body, the Nikolsky sign (+), and the Asboe-Hansen sign (+). Blood laboratory result: random blood glucose 451 mg/dl, HbA1c 12.3%. Histopathological examination: suprabasal blister, in which the basal cells still attached to the basement membrane show a “tombstone” appearance. The diagnosis was steroid-induced diabetes in pemphigus vulgaris. He was treated with steroids and insulin.
Conclusion: Steroid use in PV treatment can lead to metabolic complications, such as diabetes mellitus. Regularly monitoring is needed to prevent complications due to steroid use.
Stanley J.R. Pemphigus. Wolff K, Goldsmith L, Katz S, Gilchrest B, Paller AS, Leffell D. Fitzpatrick's Dermatology in General Medicine. 7th Edition. New York. McGraw-Hill. 2008. 459.
Wiryadi B.E. Chronic Vesicobulous Dermatosis. Menaldi S.L.S.W. dermatology and venereology. 7th ed. Jakarta. UI publishing. 2017. 234-238.
Kilic A. Pemphigus: Subtypes, Clinical Features, Diagnosis, and Treatment. In Autoimmune Bullous Diseases 2017.Dec 20. IntechOpen.
Silva SC, Nasser R, Payne AS, Stoopler ET. Pemphigus vulgaris. Journal of Emergency Medicine. 2019 Jan 1;56(1):102-4.
Darjani A, Nickhah N, Emami MH, Alizadeh N, Rafiei R, Eftekhari H, Nejad KG. Assessment of the prevalence and risk factors associated with glucocorticoid-induced diabetes mellitus in pemphigus vulgaris patients. Acta Medica Iranica. 2017 Aug 19:375-80.
Kant, Ravi & Hazarika, Neirita & Kansal, Naveen & Dhanta, Aditi. (2019). Secondary Diabetes Mellitus in Pemphigus Vulgaris and Management Issues. Clinical Dermatology Review. 3. 10.4103/CDR.CDR_36_18. Available at https://www.researchgate.net/publication/336459404_Secondary_Diabetes_Mellitus_in_Pemphigus_Vulgaris_and_Management_Issues
McMillan R, Taylor J, Shephard M, Ahmed R, Carrozzo M, Setterfield J, Grando S, Mignogna M, Kuten-Shorrer M, Musbah T, Elia A. World Workshop on Oral Medicine VI: a systematic review of the treatment of mucocutaneous pemphigus vulgaris. Oral surgery, oral medicine, oral pathology and oral radiology. 2015 Aug 1;120(2):132-42.
Surya V, Kumar P, Gupta S, Urs AB. Childhood pemphigus vulgaris: Report of two cases with emphasis on diagnostic approach. Contemporary clinical dentistry. 2018 Sep;9(Suppl 2):S373.
Dowling JR, Anderson KL, Huang WW. Asboe-Hansen sign in toxic epidermal necrolysis. Cutis. 2019 Apr 1;103(4):E6-8.
Setyawati NK, Sari AN, Mahariski PA. Glucocorticoid-induced hyperglycemia (GIH) in pemphigus vulgaris patient at Bangli District General Hospital: A case report.
Porro AM, Hans Filho G, Santi CG. Consensus on the treatment of autoimmune bullous dermatoses: pemphigus vulgaris and pemphigus foliaceus-Brazilian Society of Dermatology. Anais brasileiros de dermatologia. 2019 Apr;94(2):20-32.
Harman KE, Brown D, Exton LS, Groves RW, Hampton PJ, Mohd Mustapa MF, Setterfield JF, Yesudian PD, McHenry PM, Gibbon K, Buckley DA. British Association of Dermatologists’ guidelines for the management of pemphigus vulgaris 2017. British Journal of Dermatology. 2017 Nov;177(5):1170-201.
AL-Jurayyan NA, AL-Jurayyan AN, Al Issa SD. Steroid-Induced Hyperglycemia: A Review. Int J Med Res Prof [Internet]. 2016;2(6):2-5.
Hwang JL, Weiss RE. Steroid‐induced diabetes: a clinical and molecular approach to understanding and treatment. Diabetes/metabolism research and reviews. 2014 Feb;30(2):96-102.
Morris D. Steroid-induced diabetes and hyperglycaemia. Part 2: management. Diabetes & Primary Care.2018;20: 183–7