Linear IgA bullous dermatosis induced by diclofenac sodium

Sarita Sanke, Abhinav Kumar, Ram Chander

 Department of Dermatology and S.T.D., Lady Hardinge Medical College and Associated Hospitals, New Delhi, India

Correspondence Address:
Sarita Sanke
Department of Dermatology and S T D, Lady Hardinge Medical College and Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi - 110 001
India

An 18-year-old female presented with multiple, fluid-filled lesions all over the body of 5 days duration, which was preceded by intake of oral diclofenac 100mg for leg pain 3 days prior to the development of lesions. Cutaneous examination showed multiple, clear, fluid-filled as well as hemorrhagic vesicles and bullae all over the body ranging from 0.5 cm to 4 cm in diameter forming a “string of pearl” configuration [Figure - 1]. All mucosae were normal. Nikolsky's sign and bulla spread sign were negative. Histopathology from a fresh vesicle showed subepidermal blister with perivascular and interstitial inflammatory infiltrate composed of neutrophils and eosinophils.. Direct immunofluorescence from the perilesional skin revealed linear deposition of IgA along the dermo-epidermal junction. The Naranjo score for adverse drug reaction was 7 (probable drug reaction). In the absence of any other precipitating factors, constitutional features, and normal laboratory findings, a diagnosis of linear IgA bullous disease induced by diclofenac sodium was made.

Figure 1: Multiple clear to hemorrhagic fluid-filled bullae in a “string of pearl” configuration

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