Dipeptidyl peptidase-4 억제제 관련 수포성 유천포장의 임상병리조직학적 특징

다국어 초록 (Multilingual Abstract)

Background: Bullous pemphigoid （BP） is a representative autoimmune subepidermal blistering disease that primarily affects older adults. Recently, increasing attention has been paid to BP occurring in association with commonly prescribed medications such as dipeptidyl peptidase-4 （DPP-4） inhibitors and statins. However, the clinical, hematologic, and histopathologic characteristics of BP associated with these medications have not yet been sufficiently characterized.

Objective: To compare the clinical, hematologic, and histopathologic characteristics of BP according to DPP-4 inhibitor and statin exposure.

Methods: We retrospectively reviewed 32 patients diagnosed with BP at Yeungnam University Medical Center between January 2023 and January 2026. Diagnosis was based on clinical findings, histopathologic examination, and direct immunofluorescence. Patients were classified into a drug-associated group, defined as exposure to a DPP-4 inhibitor and/or statin, and a non-exposed group. Additional analyses were performed according to exposure to each individual drug class. Histopathologic eosinophilic infiltration was quantified as the mean eosinophil count in five high-power fields.

Results: Of the 32 patients, 5 had exposure to a DPP-4 inhibitor only, 9 to a statin only, 6 to both drugs, and 12 to neither drug. Baseline clinical characteristics were largely comparable between the drug-associated and non-exposed groups, and hematologic parameters, including peripheral eosinophil percentage and absolute eosinophil count, showed no significant differences. Histopathologic eosinophilic infiltration was significantly lower in the drug-associated group than in the non-exposed group （median 11.0 vs. 18.7, p=0.011）. In analyses according to individual drug exposure, DPP-4 inhibitor users showed significantly lower histopathologic eosinophilic infiltration than non-users （median 4.2 vs. 15.8, p=0.035）, whereas statin use was not associated with a significant difference （median 14.6 vs. 15.6, p=0.496）.

Conclusion: BP associated with DPP-4 inhibitor exposure may show reduced histopathologic eosinophilic infiltration, suggesting distinct local immunopathologic features. In contrast, no significant histopathologic difference was observed according to statin use. These findings suggest that decreased eosinophilic infiltration on histopathology may provide an ancillary clue when considering possible drug association in BP, particularly in patients exposed to DPP-4 inhibitors.

Keywords: Dipeptidyl-Peptidase IV Inhibitors; Eosinophils; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Pemphigoid, Bullous

목차 (Table of Contents)

• 서론 1
• 대상 및 방법 4
• 결과 8
• 고찰 11
• 결론 18
• 참고 문헌 19
• 영문 초록 34