Abstract: A 62-year-old female patient developed pruritus after 5 months of oral dapagliflozin treatment for type 2 diabetes mellitus. The symptoms progressively worsened with prolonged medication administration, eventually leading to the formation of blisters. Based on the combined results of skin histopathology, immunofluorescence assay and antibody detection, a diagnosis of epidermolysis bullosa acquisita was made. Previous case reports have documented that sodium-glucose cotransporter 2 inhibitors (SGLT2-Is) can induce vasculitis, psoriasis, Sweet's syndrome, bullous pemphigoid (BP) and other disorders. Therefore, the patient's condition was considered to be possibly associated with dapagliflozin. Dapagliflozin was discontinued accordingly, and the patient was prescribed oral metformin and glimepiride for glycemic control, together with oral prednisone acetate tablets (30 mg once daily) and mycophenolate mofetil (1 g twice daily). After 2 months of treatment, only brown macules remained, and the level of anti-type Ⅶ collagen antibody decreased from 45.08 U/mL before treatment to 8.22 U/mL. During a 6-month follow-up period, the dosage of glucocorticoid was tapered to 5 mg daily, and the patient's condition remained stable without recurrence.

Key words: dapagliflozin, epidermolysis bullosa acquisita, type 2 diabetes, sodium-glucose cotransporter-2 inhibitors, dipeptidyl peptidase 4, bullous pemphigoid