Oral bullous eruption after taking lisinopril—case report and literature review

Drug-induced lesions of oral mucosa are well-established side effect of different commonly used drugs. A female patient under treatment for hypertension with an angiotensin-converting enzyme inhibitor (ACE inhibitor), lisinopril, developed blisters and ulcerations on oral mucosa 3 weeks after lisinopril intake. Due to clinical finding drug-induced pemphigus was considered. However, direct and indirect immunofluorescence anal­ysis revealed no autoantibodies that are commonly present in pemphigus while histological study suggested allergic reaction. Lisinopril was discontinued from further therapy and after a month after her first arrival patient has experienced complete remission of the disease. This case raises the question, whether the term pemphigus in drug-induced reactions could be used when immunopathological criteria for pemphigus are not fulfilled.