A 45-year-old woman on penicillamine for Wilson's disease develops oral erosions and flaccid blisters. Which drug-induced bullous disorder most closely resembles this presentation immunologically?

• A Drug-induced pemphigus foliaceus mimicking anti-Dsg1 production
• B Drug-induced pemphigus vulgaris with anti-Dsg3 antibodies ✓
• C Drug-induced linear IgA bullous dermatosis
• D Drug-induced epidermolysis bullosa acquisita

Explanation

Penicillamine (and captopril, containing thiol groups) classically induces pemphigus vulgaris-like disease with anti-Dsg3 antibodies, presenting with oral erosions and flaccid blisters. The drug may biochemically modify Dsg3 or trigger autoimmunity. In contrast, drugs like rifampicin tend to cause foliaceus-like patterns. Stopping the drug often leads to remission, though immunosuppression may be required if antibodies persist.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.