Pemphigus-like reactions

In very rare cases, certain penicillins can cause pemphigus vulgaris (143) or pemphigoid-like reactions (144,145). 

Mucocutaneous reactions (1982) Halla JT +, Am J Med 72, 423 Mucosal lesions (pemphigus-like)... 

Hypersensitivity reactions are frequent early in a course of penicillamine, with urticarial or maculopapular rashes, fever, and lymphadenopathy. Cross-allergy to penicillin can occur. In addition, the use of penicillamine can be complicated by a unique variety of often serious autoimmune reactions, involving the skin, kidneys, liver, lungs, muscles, or other organs. Proteinuria is found in more than 10% of patients and sometimes develops into the nephrotic syndrome. Pemphigus, myasthenia gravis, polymyositis, or a lupus-like syndrome occur in smaller percentages. 

In usual doses, 600-800 mg/day, pyritinol has a profile of adverse reactions reminiscent of that of penicillamine (2,3). Some 40% of users have adverse reactions, leading to withdrawal in about 23% of the total. The most common are non-specific rashes and stomatitis in addition, pemphigus, lichen planus, and photosensitivity have occurred. Gastrointestinal symptoms (diarrhea, gastral-gia, nausea, loss of taste) can occur, but are less frequent than with penicillamine. Thrombocytopenia, reversible extramembranous glomerulonephritis with nephrotic syndrome (4), a myasthenia-like picture, and acute polymyositis with positive rechallenge have also been described (5). 

In a collaborative study of the French Pharmacovigilance Centers there were 23 reports of suspected reactions to pyritinol, including four cases of pemphigus, three of agranulocytosis (but other drugs taken were oxyphenbutazone or clomipramine), two of nephrosis, and two of a lupus-like syndrome (6). 

Additional side effects reported in connection with rifampicin treatment were severe exudative conjunctivitis (Cayley and Majumdar 1976), the occurrence of the Stevens-Johnson syndrome (Nyirenda and Gill 1977) and pemphigus vulgaris (Gange et al. 1976). All information on adverse reactions to rifampicin has been obtained from studies of patients afflicted with tuberculosis. It is likely that similar observations will be made when patients with other diseases are treated with similar doses, but this has yet to be demonstrated. 

Penicillamine is a chelating agent which binds copper, mercury, zinc, and lead. It has been used to treat poisoning from these chemicals and also for disorders of copper metabolism such as Wilson s disease and primary biliary cirrhosis. Penicillamine has been tried in scleroderma and arthritis. Hypersensitivity reactions are common. About 20%-30% of the patients show hypersensitivity reactions suchs as morbilliform exanthema, urticaria, purpura, anorexia, lymphadenopathy, leukopenia, and thrombocytopenia (Meyboom 1975 Balme and Huskisson 1977). More severe skin symptoms associated with penicillamine therapy are Stevens-Johnson syndrome, pemphigus, myasthenia gravis, cholestatic jaundice (Barzilai et al. 1978), nephropathy (Lange 1978) and lupus-like syndrome (Harpey et al. 1972). 

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