International Journal of Scientific Reports | July 2015 | Vol 1 | Issue 3 Page 184 International Journal of Scientific Reports Mukherjee S. Int J Sci Rep. 2015 Jul;1(3):184-186 http://www.sci-rep.com pISSN 2454-2156 | eISSN 2454-2164 Case Report Metformin induced bullous pemphigoid, the first case Sudeb Mukherjee* INTRODUCTION Bullous pemphigoid is a polymorphic autoimmune subepidermal blistering disease seen in elderly individuals. Exact etiology of this autoimmune process is not known. Induced bullous pemphigoid has been associated with several drugs but metformin is not one of them. Being the first line agent in the treatment of type 2 Diabetes Mellitus (DM) metformin is used widely. Here I have reported one such rare case of metformin induced Bullous Pemphigoid (BP) which has not been reported in medical literature so far. CASE REPORT A 64 year old female with history of type 2 DM attended OPD with uncontrolled glycaemic status. Her Fasting Plasma Glucose (FPG) was 192 mg/dl, Post Prandial Plasma Glucose (PPPG) 265 mg/dl and HbA1C 8.7%. She was on regular Soluble Insulin injection thrice daily. She was advised to take metformin 500 mg twice daily along with increase in the dose of regular meal time insulin injection and to visit after 2 weeks. After 12 days she came to emergency department with erythematous blistering lesions involving both upper limb, trunk, lower limb and scalp region. On examination it was found that erythematous bullous lesions were tense, contained clear fluid and were of varying sizes (4 cm - 8 cm in diameter) (Figure 1). There was no mucosal involvement. Figure 1: Showing tense fluid filled bullae over flexor aspect of arm. She was admitted and treated for drug hypersensitivity reaction and skin biopsy was sent for histopathology examination and direct immunofluorescence. At that time ABSTRACT Bullous pemphigoid is a polymorphic autoimmune subepidermal blistering disease seen in elderly individuals. Exact etiology of this autoimmune process is not known. Induced bullous pemphigoid has been associated with several drugs but metformin is not one of them. Here I have reported one such rare case of metformin induced Bullous Pemphigoid (BP). Keywords: Bullous pemphigoid, Metformin Department of Medicine, R.G. Kar Medical College & Hospital, Kolkata, West Bengal, India Received: 26 June 2015 Accepted: 19 July 2015 *Correspondence: Dr. Sudeb Mukherjee E-mail: drsumukherjee@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20150357