A Case Of Hydralazine Induced Bullous Pemphigoid

A Case Report details an 89-year-old Caucasian lady who developed a generalized, itchy, bullous rash about two weeks after her doctor started her on hydralazine for high blood pressure. Bullous pemphigoid (BP) secondary to hydralazine was suspected. A skin biopsy with direct immunofluorescence confirmed the diagnosis, showing linear deposition of IgM and C3 along the basement membrane zone. Hydralazine-induced BP is a rare adverse drug reaction where the drug may act to trigger an autoimmune response against proteins in the dermal-epidermal junction. The cornerstone of management was the immediate discontinuation of hydralazine, and the patient was started on oral prednisolone. Her rash improved within days and resolved within one month, demonstrating the good prognosis often seen with prompt drug withdrawal. This case highlights the necessity of considering hydralazine as a potential cause of BP.