A CASE REPORT OF NEPHROTIC SYNDROME AND BULLOUS PEMPHIGOID IN ASSOCIATION WITH NICORANDIL

R SHETTIGAR1
1Dunedin Public Hospital, New Zealand, Dunedin, New Zealand

Introduction: Nicorandil is a potassium channel activator used for the treatment for refractory angina. GIT ulceration associated with Nicorandil is well reported , however to our knowledge this is the first case report of Nicorandil causing FSGS and Bullous pemphigoid.
Case report:  81 year old female presented with bullous skin lesions and nephrotic syndrome. Nicorandil was commenced for refractory angina 6 months ago and it had been stopped due to blistering skin lesions. Due to ongoing angina, Nicorandil was recommenced approximately 4 weeks prior to current presentation.  Bullous lesions reappeared followed by onset of leg oedema and swelling. She underwent a renal and skin biopsy which showed Focal segmental glomerulosclerosis and bullous pemphigoid respectively. Nicorandil was discontinued and prednisone 40mg was commenced. The nephrotic syndrome remitted within one week and the skin lesions have completely healed with no further new lesions.
Conclusion:  Nicorandil has been increasingly used for the management of refractory angina. In our case, it  was associated with causing cutaneous lesions and glomerular injury which completely remitted after stopping the drug. Awareness of possibility of this condition is crucial for prescribers.


Biography:
I am first year renal advance trainee at Dunedin Hospital. I graduated from Mumbai and moved to New Zealand 5 years ago. I worked as a tutor at medical school in Otago and Auckland before taking up full time work as a house officer in Dunedin Hospital. I have a keen interest in Renal transplantation and would like to pursue a career in the same field. When not at work, I enjoy travelling , dance training and reading.

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