Drug-induced subacute cutaneous lupus erythematosus in previously diagnosed systemic lupus erythematosus patients: A case series (original) (raw)
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Topical drug-induced subacute cutaneous lupus erythematosus isolated to the hands
Lupus science & medicine, 2017
Subacute cutaneous lupus erythematosus (SCLE) is a well-defined subtype of lupus erythematosus, characterised by photosensitivity, annular and/or psoriasiform lesions, variable systemic involvement and presence of circulating SSA/anti-Ro antibodies. SCLE may be idiopathic or drug-induced. Both the idiopathic and drug-induced forms of SCLE are analogous in their clinical, serological and histological features. Drug-induced SCLE has been reported with various oral agents, but to our knowledge this is the first reported case due to a topical medication. A 34-year-old female foot masseuse presented with a 2-month history of scaly, erythematous lesions isolated to the dorsal hands and interdigital spaces. She had used topical terbinafine, a topical antifungal cream, to her clients' feet for a number of years. ANA and anti-SSA/Ro antibodies were positive. Physical examination, serology and histopathology were consistent with SCLE. We propose that our patient's unique presentation ...
Acta Medica Philippina
Case Presentation A previously healthy 50-year-old female presented at our emergency room (ER) with decreased sensorium. Six weeks prior to admission (PTA), she experienced fever, dysuria, and bipedal edema which prompted consult at a local hospital. Urinalysis showed pyuria [white blood cell (WBC) 18-25/high-power field (HPF)] with bacteriuria and proteinuria (+3). Complete blood count (CBC) revealed leukocytosis (WBC 13.8 x 10 9 /L) with 85% neutrophil predominance and a hemoglobin (Hb) level of 165 g/L. She was treated for urinary tract infection with cefuroxime. She was also given hydrochlorothiazide (HCTZ) and prednisone, presumably for the edema and proteinuria. Three days later, she developed erythematous, target-like plaques starting on the extremities then involving the trunk. She also had oral ulcers and occasional joint and low back pain. The patient consulted another physician who shifted her antibiotic to ciprofloxacin for 2 days, then to co-amoxiclav. After another 2 days, the patient discontinued the antibiotics and instead took herbal medications (i.e., reishi gano, ganocelium, spirulina, morinzhi, ganozhi) prescribed by an iridologist. Her skin lesions progressed, prompting consult CASE RECORDS OF THE DEPARTMENT OF MEDICINE, PHILIPPINE GENERAL HOSPITAL
Drug-induced lupus erythematosus
Archives of Dermatological Research, 2009
Drug-induced lupus erythematosus (DILE) is deWned as a lupus-like syndrome temporally related to continuous drug exposure which resolves after discontinuation of the oVending drug. There are currently no standard diagnostic criteria for DILE and the pathomechanisms are still unclear. Similarly to idiopathic lupus, DILE can be diveded into systemic (SLE), subacute cutaneous (SCLE) and chronic cutaneous lupus (CCLE). Systemic DILE is characterized by typical lupus-like symptoms including skin signs, usually mild systemic involvement and a typical laboratory proWle with positive antinuclear and anti-histone antibodies, while anti-double strand (ds) DNA and antiextractable nuclear antigens antibodies are rare. High risk drugs include hydralazine, procainamide and isoniazid. Drug-induced SCLE is very similar to idiopathic SCLE in terms of clinical and serologic characteristic, and it is more common than the systemic form of DILE. Drugs associated with SCLE include calcium channel blockers, angiotensinconverting enzyme inhibitors, interferons, thiazide diuretics and terbinaWne. Drug-induced CCLE is very rarely reported in the literature and usually refers to Xuorouracile agents or non steroidal anti-inXammatory drugs. Recently, cases of DILE have been reported with anti-TNF agents. These cases present with disparate clinical features including arthritis/arthralgia, skin rash, serositis, cytopenia and variable laboratory abnormalities. DILE to anti-TNF agents diVers in several ways to classic DILE. The incidence of rashes is higher compared to classical systemic DILE. In most cases of classic DILE visceral involvement is rare, whereas several cases of anti-TNF DILE with evidence of renal disease have been reported. Low serum complement levels as well as anti-extractable nuclear antigen antibodies and anti-dsDNA antibodies are rarely present in classic DILE, whereas they are reported in half the cases of anti-TNF DILE; in contrast, anti-histone antibodies are described in classic DILE more often than in anti-TNF DILE. Recognition of DILE in patients receiving anti-TNF therapy can be diYcult due to the symptoms of their underlying disease. A temporal association (months to years) of the oVending drug with characteristic or suggestive symptoms, and resolution of symptoms on drug withdrawal is the best evidence for this diagnosis of DILE.
An atypical case of drug-induced lupus syndrome
MOJ Clinical & Medical Case Reports, 2018
DIL is an autoimmune vasculitis against certain drugs that lead to autoantibodies in some patients causing a clinical syndrome with similar clinical manifestations of SLE. A 30 year old female was admitted for dry cough, polyarthralgia, and subfebrile fever that arouse three weeks after termination of antibiotic treatment for maxillary sinusitis. Computed tomography revealed multiple subpleural nodules. BAL culture was negative for bacteria, fungus, and ARB. Histopathologic examination of the TBB specimen revealed granulomatous inflammation. ANA, P-ANCA, MPO-ANCA, PR3-ANCA was positive while anti-ds-DNA, C-ANCA, C3 and C4 were negative. Anti-histone antibody was high. Symptoms resolved within three months after methylprednisolone treatment. Final diagnosis was DIL due to amoxicillin clavulanate. Certain drugs may trigger an autoimmune response causing DIL that has similarities to SLE with crucial differences in clinical and immunologic features. Our case was a diagnostic challenge due to its atypical presentation with significant overlap of the clinical and laboratory findings.
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2012
Drug-induced lupus erythematosus (DILE) is a lupus-like syndrome temporally related to continuous drug exposure which resolves upon drug discontinuation. There are currently no standard diagnostic criteria for DILE. Findings include skin manifestations, arthritis, serositis, anti-nuclear and anti-histone antibodies positivity. Similarly to idiopathic lupus erythematosus, DILE can be divided into systemic (SLE), subacute cutaneous (SCLE) and chronic cutaneous lupus (CCLE). Systemic DILE presents as a milder version of idiopathic SLE, and the drugs most frequently implicated are hydralazine, procainamide and quinidine. Anti-TNFa therapies are the latest class of medications found to be associated, although rarely, with a "lupus-like" syndrome, which is however clinically distinct from classical DILE. Drug-induced SCLE is the most common form of DILE. It is very similar to idiopathic SCLE in terms of clinical and serologic characteristics. The most commonly implicated drugs are antihypertensive drugs and terbinafine, but in recent years also proton pump inhibitors and chemotherapeutic agents have been associated. Drug-induced CCLE is very rare and usually caused by fluorouracil agents and NSAIDS, but some cases have induced by pantoprazole and anti-TNFa agents.
Proton pump inhibitor‐induced subacute cutaneous lupus erythematosus
British Journal of Dermatology, 2014
Background Drug-induced subacute cutaneous lupus erythematosus (SCLE) has been known in the literature since 1985 and is increasingly recognized. Objectives To identify and describe patients with proton pump inhibitor (PPI)induced SCLE. Methods A retrospective medical chart review of patients diagnosed with lupus erythematosus at the Department of Dermatology and Allergy Centre was carried out over a 19-year period. A causality assessment to PPI was performed using the Naranjo probability scale. Results Twenty-four patients with PPI-induced SCLE were identified (21 women and three men). Nineteen patients were newly identified cases, with a mean age of 61 years. These patients had 24 episodes of PPI-induced SCLE comprising lansoprazole (12), omeprazole (six), esomeprazole (four) and pantoprazole (two). Four patients had multiple episodes and three patients reacted to different PPIs. The incubation period was on average 8 months (range 1 week to 3Á5 years) and the resolution period was on average 3 months (range 4 weeks to 8 months). Antinuclear antibodies were positive in 61% of tested patients, most frequently with a speckled pattern. Positive anti-Ro/SSA antibodies were found in 73%, anti-La/SSB antibodies in 33% and antihistone antibodies in 8% of tested patients at the time of the eruption. The skin rash was often widespread with a tendency to bullous lesions and focal skin necrosis. Conclusions We present the largest case series of PPI-induced SCLE reported to date, and our patient cohort reveals the lack of attention to this condition. The diagnosis may be suspected on the clinical picture, and most patients have anti-Ro/SSA antibodies, while antihistone antibodies have no value in the diagnostic process. Cross-reactivity can be seen between different PPIs. What's already known about this topic? • Eighteen cases of proton pump inhibitor (PPI)-induced cutaneous lupus erythematosus (CLE) have been reported in the literature since 2001. What does this study add? • Nineteen new patients with 24 episodes of PPI-induced subacute CLE (SCLE) are reported. • Cross-reactivity between different PPIs is demonstrated. • Patients with previous CLE or other autoimmune diseases may be particularly prone to PPI-induced or exacerbated SCLE. • The diagnosis is challenged by the variation in time from prescription of the culprit drug to the appearance of SCLE.