{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T11:33:50Z","timestamp":1788089630813,"version":"build-2803163510"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Epidermolysis bullosa acquisita (EBA) is a rare autoimmune blistering disease caused by autoantibodies to type VII collagen. While dipeptidyl peptidase-4 (DPP-4) inhibitors are established triggers for bullous pemphigoid (BP), their association with EBA has not been reported. A 68-year-old Japanese man with type 2 diabetes and chronic renal dysfunction, treated with linagliptin, developed widespread tense blisters with mucosal involvement. Histopathology and immunological studies confirmed EBA. Despite corticosteroids, cyclosporine, pulse therapy, and intravenous immunoglobulin, the disease remained refractory. Eighty days after onset, he developed pneumonia, renal failure requiring dialysis, and severe thrombocytopenia. After exclusion of other causes, immune thrombocytopenic purpura (ITP) was clinically diagnosed. Although treatment yielded transient platelet recovery, the patient ultimately died. This is the first reported case of EBA following DPP-4 inhibitor therapy complicated by ITP. It highlights the therapeutic challenges of EBA and the potential for systemic autoimmune manifestations beyond the skin in patients receiving DPP-4 inhibitors.<\/jats:p>","DOI":"10.3389\/fimmu.2025.1724412","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T06:38:12Z","timestamp":1767595092000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case report: Epidermolysis bullosa acquisita following dipeptidyl peptidase-4 inhibitor therapy and complicated by immune thrombocytopenic purpura"],"prefix":"10.3389","volume":"16","author":[{"given":"Hirofumi","family":"Kawamoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natsuko","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukimi","family":"Ueda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norito","family":"Ishii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Sawada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","DOI":"10.1111\/j.1346-8138.2009.00799.x","article-title":"Epidermolysis bullosa acquisita: what\u2019s new","volume":"37","author":"Ishii","year":"2010","journal-title":"J Dermatol"},{"key":"B2","doi-asserted-by":"crossref","DOI":"10.1111\/jdv.12096","article-title":"Epidermolysis bullosa acquisita","volume":"27","author":"Kim","year":"2013","journal-title":"J Eur Acad Dermatol Venereol."},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2018.00362","article-title":"Epidermolysis bullosa acquisita: the 2019 update","volume":"5","author":"Koga","year":"2018","journal-title":"Front Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.01238","article-title":"Dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid","volume":"10","author":"Tasanen","year":"2019","journal-title":"Front Immunol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.00542","article-title":"Bullous pemphigoid triggered by thermal burn under medication with a dipeptidyl peptidase-IV inhibitor: A case report and review of the literature","volume":"9","author":"Mai","year":"2018","journal-title":"Front Immunol"},{"key":"B6","article-title":"Epidermolysis bullosa acquisita","volume-title":"StatPearls","author":"Xiao","year":"2025"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019000966","article-title":"American Society of Hematology 2019 guidelines for immune thrombocytopenia","volume":"3","author":"Neunert","year":"2019","journal-title":"Blood Adv"},{"key":"B8","doi-asserted-by":"publisher","first-page":"89","DOI":"10.5414\/CP204478","article-title":"Gliptin-induced bullous pemphigoid","volume":"62","author":"Ganeva","year":"2024","journal-title":"Int J Clin Pharmacol Ther"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2017-219998","article-title":"Linagliptin-associated blistering and ulceration","volume":"2017","author":"Psomadakis","year":"2017","journal-title":"BMJ Case Rep"},{"key":"B10","doi-asserted-by":"crossref","DOI":"10.1159\/000443330","article-title":"Three cases of bullous pemphigoid associated with dipeptidyl peptidase-4 inhibitors - 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