Valsartan Induced Bullous Pemphigoid in a Young Adult: Clinical and Immunopathological Insights

Background

Bullous pemphigoid (BP) is an autoimmune blistering disorder that predominantly affects the elderly population. Although its exact pathophysiology remains incompletely understood, a strong link to pharmacological agents has been well established. Herein, we report a rare case of valsartan-induced bullous pemphigoid in a young female patient. Presentation of Case: A 40-year-old female presented to the emergency department with a widespread cutaneous eruption associated with severe pruritus. Anamnesis revealed recent initiation of an angiotensin II receptor blocker for newly diagnosed hypertension. Clinical examination demonstrated multiple urticarial plaques with polycyclic borders, surmounted by numerous tense bullae, alongside widespread post-bullous erosions involving the entire body, with genital mucosal involvement. Skin biopsy with direct and indirect immunofluorescence was consistent with bullous pemphigoid. The antihypertensive agent was discontinued. Systemic therapy with oral prednisone was initiated and gradually tapered. The clinical outcome was favourable, showing marked disease improvement with complete re-epithelialisation of the lesions.