Vildagliptin-induced Polyarthritis: First Documented Case with Positive Rechallenge and Complete Reversal

Globally, type 2 diabetes mellitus represents a major public health challenge with escalating prevalence, particularly in developing nations where lifestyle modifications and urbanization contribute significantly to disease burden. Dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used antidiabetic agents with generally favorable safety profiles. Polyarthritis, characterized by inflammation affecting multiple joints simultaneously, is typically associated with autoimmune conditions like rheumatoid arthritis or systemic lupus erythematosus. Drug-induced polyarthritis, while rare, has been documented with various therapeutic agents, including antimicrobials, biologics, and certain cardiovascular medications. Here, we report the first documented case of a 58-year-old female patient who developed acute polyarthritis following vildagliptin initiation, with complete resolution upon drug discontinuation and positive rechallenge confirmation. Literature review by the authors revealed only a few scattered case reports correlating other DPP-4 inhibitors with polyarthritis, but no documented cases specifically with vildagliptin rechallenge. Hence, we believe this case is particularly illuminating due to its rarity and adds valuable evidence to the limited existing literature on this potential adverse effect.