Endocrine Abstracts

Introduction: Incretin based therapeutics have commonly been used in the last years for the management of patients with type 2 diabetes mellitus (DM). Linagliptin is a member of “dipeptidyl peptidase 4” (DPP-4) inhibitors and often preferred owing to some advantages over the others. We present a diabetic case developing skin findings after the initiation of linagliptin.

Case: 66 year-old woman with a history of type 2 DM for 10 years was admitted to our clinics with the complaints of dry mouth, polydipsia and polyuria. She had also history of coronary heart disease confirmed by coronary angiography. She had been taking metformin, acetylsalicylic acid, and oral nitrate for 10 years. On physical examination; vital signs and examinations of cardiovascular, pulmonary and gastrointestinal systems were normal. She had no skin rash or lesions. Blood glucose was 319 mg/dl, urine ketone negative, creatinine 0.78 mg/dl; and liver tests and arterial blood gas analysis were in normal limits. Firstly, we initiated intensive insulin regimen together with tight glucose monitoring, to improve uncontrolled hyperglycemia. We increased the dosage of rapid acting insulins gradually to achieve optimal glucose control. Metformin was continued and linagliptin was added to treatment. Lesions like palpable purpura arised on lower legs and upper arms of the patient on the second day of linagliptin therapy. No other drugs, chemicals or herbal preparations were given at this time. After cessation of linagliptin, palpable purpura lesions both on lower and upper extremities regressed gradually.

Conclusion: Due to impact of DPP-4 inhibitors on the other DPP enzymes to some degree, musculoskeletal and dermatological adverse reactions may occur during the treatment with these agents. To our knowledge, palpable purpura lesions were detected with linagliptin therapy in our patient for a first time in the literature.