Drug-Induced Pemphigus Foliaceus Potentially Triggered by Piperacillin-Tazobactam, Linezolid, and Additional Factors:...

Drug-induced pemphigus (DIP) is a rare autoimmune blistering disorder most commonly associated with thiol-containing drugs such as penicillamine, captopril, and bucillamine. However, additional medications are increasingly recognized in the nonthiol nonphenol group. While some cases require treatment with corticosteroids or immunosuppressants, in certain instances, simply discontinuing the offending drug is sufficient. We report a unique case of drug-induced pemphigus foliaceus (DIPF) potentially triggered by piperacillin-tazobactam and/or linezolid in a 69-year-old female patient on the 10th day of hospitalization while receiving treatment for necrotizing fasciitis and Streptococcus agalactiae bacteremia. To the best of our knowledge, this is the first reported case of DIP caused by piperacillin-tazobactam and/or linezolid. However, other factors may have predisposed them. The diagnosis of DIPF was confirmed through skin biopsy, direct immunofluorescence (DIF), and enzyme-linked immunosorbent assay (ELISA). Early recognition and prompt discontinuation of the suspected drugs likely prevented disease progression, emphasizing the importance of vigilance when managing patients on polypharmacy. While the exact mechanism of DIP remains unclear, potential pathways include antigen modification, immune dysregulation, or oxidative stress. This case highlights the need for heightened awareness of atypical triggers, comprehensive diagnostics, and timely intervention to optimize patient outcomes.