Ursodeoxycholic acid induced epidermolysis bullosa

A 69-year-old female patient suffered from cholestasis caused by acute viral hepatitis A was treated with ursodeoxycholic acid capsules 250 mg thrice daily. The patient developed facial flushing after a week. The symptoms relieved after the drug discontinuation. Three days later, the patient continued to take the medicine at the same dose, the symptom of facial flush recurred accompanied by facial swelling and systemic red rash. The medicine was discontinued immediately. The patient was under the treatment with IV infusions of vitamin C, calcium gluconate and methylprednisolone, intramuscular injection of diphenhydramine hydrochloride, oral loratadine and cetirizine hydrochloride, externally used calamine lotion, fluticasone propionate cream and fusidic acid cream. However, scattered bulla with clear liquid and cankered part appeared on the patient′s trunk skin, the diagnosis of drug eruption was made. She was given IV infusion of cefoperazone sodium and tazobactam sodium and oral mizolastine. One day later, the patient developed pain at lower limb skin, large red patches occurred on her thigh and trunk, double outer thighs with bulla of clear fluid, multiple target red patches on both legs with blisters of clear fluid. She was considered as having epidermolysis bullosa. She received an IV infusion of human immunoglobulin 20 g once daily. The target red patches were fused and formed diffuse erythema. After 3 days, the pain relived with the diffuse erythema faded away and the wizened bulla. After another two days, the blisters formed skin erosion in the thighs. After 3 days, the erosion was clean and dry, the dose of methylprednisolone was reduced. One week later, her liver function returned to normal. After 5 days, the erythema on the thigh and trunk appeared flake desquamation. Methylprednisolone was stopped and the patient received oral prednisone and externally used compound lactic acid ointment. Key words: Ursodeoxycholic acid; Epidermolysis bullosa