A case of bullous pemphigoid induced by tiobutarit (D-penicillamine analogue)

A 61-year-old woman with severe rheumatoid arthritis developed bullous lesions on the trunk, conjunctiva, and oral mucosa during treatment with tiobutarit, a new antirheumatic drug analogus to D-penicillamine. Histology showed a subepidermal blister, and circulating antibodies to the basement membrane zone were detected. The bullous lesions improved rapidly after discontinuation of tiobutarit. However, 3 years later, she was re-exposed to tiobutarit and the bullous lesions recurred within a week. This is the first confirmed case of tiobutarit-induced BP.