{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T18:45:49Z","timestamp":1766515549384,"version":"3.44.0"},"reference-count":13,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,1,5]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:p>We describe two patients, in their 70s, each presenting to the emergency department, with 6-week histories of progressively developing pruritic bullae. Both individuals had multiple comorbidities, including type 2 diabetes\u2014for which they took linagliptin, chronic kidney disease, hypertension and prosthetic heart valves. Owing to systemic illness and endocarditis secondary to superadded bacterial infections, they both required intensive treatment and prolonged hospital admissions.<\/jats:p>\n               <jats:p>Despite the beneficial effect of linagliptin on glycaemic control and its reported cardiovascular and renal safety profiles, we add our cases as evidence of the significant risk of developing bullous pemphigoid while taking this medication. Secondary infection of bullous pemphigoid increased the risk of developing endocarditis, particularly among individuals with a medical history of valve replacement surgery. Considering this, we advocate caution when prescribing this medication.<\/jats:p>","DOI":"10.1136\/bcr-2023-255358","type":"journal-article","created":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T12:25:54Z","timestamp":1707827154000},"page":"e255358","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Two cases of linagliptin-associated bullous pemphigoid resulting in sepsis and endocarditis"],"prefix":"10.1136","volume":"17","author":[{"given":"Michael","family":"Vanner","sequence":"first","affiliation":[{"name":"Medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Tanner","sequence":"additional","affiliation":[{"name":"University Hospitals Sussex NHS Foundation Trust, Brighton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Chakera","sequence":"additional","affiliation":[{"name":"Royal Sussex County Hospital, Brighton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,2,13]]},"reference":[{"key":"2025082623354097000_17.2.e255358.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clindermatol.2013.01.006"},{"key":"2025082623354097000_17.2.e255358.2","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1590\/abd1806-4841.20199007","article-title":"Bullous pemphigoid","volume":"94","author":"Miyamoto","year":"2019","journal-title":"An Bras Dermatol"},{"key":"2025082623354097000_17.2.e255358.3","article-title":"Dipeptidyl peptidase-4 (DPP-4) inhibitors for type 2 diabetes mellitus","volume":"2008","author":"Richter","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"2025082623354097000_17.2.e255358.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69705-5"},{"key":"2025082623354097000_17.2.e255358.5","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-0210"},{"key":"2025082623354097000_17.2.e255358.6","doi-asserted-by":"crossref","DOI":"10.1111\/dth.13790","article-title":"Dipeptidyl\u2010Peptidase IV inhibitors (Dpp4I)\u2010Associated Bullous Pemphigoid: estimating the clinical profile and exploring Intraclass differences","volume":"33","author":"Kridin","year":"2020","journal-title":"Dermatol Ther"},{"key":"2025082623354097000_17.2.e255358.7","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1016\/j.jaad.2017.12.038","article-title":"Dipeptidyl peptidase IV inhibitors, a risk factor for bullous pemphigoid: retrospective multicenter case control study from France and Switzerland","volume":"78","author":"Benzaquen","year":"2018","journal-title":"J Am Acad Dermatol"},{"key":"2025082623354097000_17.2.e255358.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12967-021-03192-8","article-title":"Bullous pemphigoid in diabetic patients treated by gliptins: the other side of the coin","volume":"19","author":"Chouchane","year":"2021","journal-title":"J Transl Med"},{"key":"2025082623354097000_17.2.e255358.9","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1080\/07853890.2018.1443346","article-title":"Relapse of bullous pemphigoid: an update on this stubborn clinical problem","volume":"50","author":"Wang","year":"2018","journal-title":"Ann Med"},{"key":"2025082623354097000_17.2.e255358.10","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1111\/bjd.19611","article-title":"International validation of the bullous pemphigoid disease area index severity score and calculation of cut\u2010off values for defining mild, moderate and severe types of bullous pemphigoid","volume":"184","author":"Masmoudi","year":"2021","journal-title":"Br J Dermatol"},{"key":"2025082623354097000_17.2.e255358.11","unstructured":"The use of the WHO-UMC system for standardised case causality assessment, Available: https:\/\/www.who.int\/docs\/default-source\/medicines\/pharmacovigilance\/whocausality-assessment.pdf [Accessed 23 Sep 2023]."},{"key":"2025082623354097000_17.2.e255358.12","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-0287"},{"key":"2025082623354097000_17.2.e255358.13","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1080\/00365540500277367","article-title":"Does steroid exposure adversely affect the outcome of subacute bacterial endocarditis? Report of two cases","volume":"38","author":"Ahmad","year":"2006","journal-title":"Scand J Infect Dis"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-255358","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:35:50Z","timestamp":1756276550000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-255358"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2]]},"references-count":13,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2,13]]},"published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1136\/bcr-2023-255358"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-255358","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2024,2]]}}}