Lesions resembling discoid lupus erythematosus dle have been the most common presentation, but le tumidus has. A recent similar case report of pembrolizumabrelated subacute cutaneous lupus erythematosus was provided. Muscle and joint pain and swelling flulike symptoms of fatigue and fever. Related conditions are druginduced cutaneous lupus and. Dile or dil can occur as a sideeffect of certain medications.
Druginduced lupus erythematosus dile is a lupuslike illness that has been recognized as an entity under environmentallyinduced lupus erythematosus, where other agents such as physical ultraviolet irradiation, chemical heavy metals, aromatic amines and food products alfalfa sprouts have been implicated. The high femaletomale ratio associated with sle is not seen with druginduced lupus. Acute interstitial nephritis and druginduced systemic. The symptoms of druginduced lupus are similar to those of systemic lupus, but only rarely will any major organs be affected.
The drugs most commonly implicated are hydralazine, procainamide, quinidine, isoniazid, diltiazem. Druginduced lupus is when its caused by taking certain prescription medicines for months or years at a time. Pdf druginduced lupus erythematosus nikolai tsankov. The drugs most commonly connected with druginduced lupus are hydralazine used. Here, we report the case of a 39yearold man with onset of cutaneous discoid lupus erythematosus during subcutaneous administration of the il17a. How is druginduced lupus erythematosus differentiated. The following products are considered to be alternative treatments or.
Among the numerous idiopathic immunemediated diseases that can be druginduced, such as pemphigus, psoriasis, lichen, etc, druginduced lupus is the most widely commented upon and investigated. Druginduced chronic cutaneous le is the rarest of the three forms. Systemic lupus erythematosus sle is an autoimmune disease of unknown origin, but many. Druginduced lupus erythematosus statpearls ncbi bookshelf. Druginduced systemic lupus erythematosus associated with. The use of drugs linked to druginduced lupus have not been associated with an increase in sle activity or onset of flares. Druginduced lupus dil is a disorder with clinical, histological, and immunological features similar to idiopathic systemic lupus erythematosus, but that occurs when certain drugs are taken and resolves after discontinuation of the offending agent. Druginduced lupus is a lupuslike disease caused by certain prescription drugs. There is no evidence that people with sle are more likely to develop druginduced lupus. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels. The use of the abbreviation sle means idiopathic sle throughout this chapter. In their article in the june 1978 issue of chest, kaplan et al 1 x 1 kaplan, ai, zakher, f, and sabin, s.
Druginduced lupus dil is a disorder with clinical, histological, and immunological features similar to idiopathic systemic lupus erythematosus, but that occurs when certain drugs are taken. Druginduced lupus erythematosus is a lupuslike syndrome temporally related to continuous drug exposure that resolves after discontinuation of the offending drug. The symptoms of druginduced lupus are like those of sle, such as joint pain, muscle pain, and fever. It appears on average, eight months after starting the trigger medication. Causes of lupus or systemic lupus erythematosus sle. The utility of antihistone antibody screening in the. We had considered if this could have represented a systemic lupus erythematosus picture from the onset of the inflammatory arthritis, however, the initial ana was normal. The terms druginduced lupus dil and druginduced lupus erythematosus dile are preferred, but other ones are also useddrugrelated lupus, lupuslike syndrome, and lupus erythematosus medicamentosus.
A chronic, inflammatory autoimmune disorder that may affect many organ systems including the skin, joints, and internal organs. Symptoms vary between people and may be mild to severe. Druginduced lupus erythematosus clinics in dermatology. Sle is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. This means your body attacks healthy tissue by mistake. Common symptoms include painful and swollen joints, fever, chest pain, hair loss, mouth ulcers, swollen lymph nodes, feeling tired, and a red rash which is. Men over 50 years of age usually get affected with druginduced lupus as they are very much at a risk for developing chronic diseases that require prolonged usage of medications like hydralazine that is prescribed for hypertension and quinidine or procainamide that are.
Over 100 drugs have been reported to cause druginduced lupus dil, including a number of the newer biologics and antiviral agents. Druginduced lupus erythematosus actas dermosifiliograficas. Druginduced lupus erythematosus dile is marked by the development of immunological and dermatological manifestations after the initiation of one or more medications while hydralazine and antihistone antibodies are the bestknown examples, other drugs have been known to cause a lupuslike reaction. Druginduced lupus is a syndrome which share symptoms and laboratory characteristics with idiopathic systemic lupus erythematosus sle. The terms druginduced lupus dil and druginduced lupus erythematosus dile are preferred, but other ones are also useddrugrelated lupus, lupuslike syndrome and lupus erythematosus medicamentosus. This disorder has been described for the first time in 1945 by hoffman. Inherited differences in drug metabolism eg, acetylator status and immunogenetic characteristics are genetic factors that may influence the risk of developing disease.
Secukinumabinduced chronic discoid lupus erythematosus. Characteristics of druginduced lupus erythematosus. Both the idiopathic and druginduced forms of scle are analogous in their clinical, serological and. Druginduced lupus dil is an autoimmune phenomenon where a drug exposure leads to the development of systemic lupus erythematosus. Some lids induce a condition more akin to subacute cutaneous lupus erythematosus scle consequently, unless stated otherwise, reference to dil in this chapter means the term to encompass druginduced sle, scle and ccle chronic cutaneous lupus erythematosus. A suspected case of isoniazidinduced systemic lupus erythematosus was confirmed by the presence of serum antinuclear antibodies. In their report of systemic lupus erythematosus sle associated with etanercept, najia shakoor and colleagues feb 16, p 5791 discuss four patients who developed antinuclear antibodies, or antibodies to doublestranded dna dsdna or histones. The classic example is druginduced lupus erythematosus dile. We report the clinical case of an 80yearold woman in which a framework of dile was. Some symptoms overlap with those of systemic lupus erythematosus sle. Systemic lupus erythematosus foot and ankle center of massachusetts, p.
The terms druginduced lupus dil and druginduced lupus erythematosus dile are preferred, but other ones are also useddrugrelated lupus, lupuslike syndrome, and lupus. Druginduced lupus erythematosus dile is a variant of lupus erythematosus that resolves within days to months after withdrawal of the culprit drug in a patient with no underlying immune system dysfunction. Many pharmacologic agents have been associated with a lupuslike syndrome see see druginduced lupus erythematosus, but procainamide, hydralazine. The terms druginduced lupus dil and druginduced lupus erythematosus dile are preferred, but other ones are also useddrugrelated lupus, lupuslike syndrome, and lupus erythematosus. Druginduced lupus erythematosus is a rare adverse event of biological treatment, mainly observed with tumor necrosis factor. Isoniazid, an antituberculosis drug, can cause systemic lupus erythematosus sle. Mary anne dooley, in systemic lupus erythematosus, 2016. Although cutaneous lupus can cause many types of rashes and lesions sores, the most commoncalled discoid rashis raised, scaly and red, but not itchy. Druginduced lupus erythematosus information mount sinai.
Cardiovascular drugs are an important group of drugs with potential risk of developing adverse cutaneous drug reaction especially in the elderly as marketing of more new drugs and their prescription continue to increase. Lupus, technically known as systemic lupus erythematosus sle, is an autoimmune disease in which the bodys immune system mistakenly attacks healthy tissue in many parts of the body. Report of 35 cases with discussion of seven apparently induced by anticonvulsant medication, prognosis, and treatment, pediatrics 32. Systemic lupus erythematosus sle, is the most common type of lupus. Recently, it was also described with interleukin il 17 inhibition. The mechanism or mechanisms involved in druginduced lupus remain uncertain. An increasing number of drugs have been linked to druginduced subacute cutaneous lupus erythematosus discle.
This report is the first series of cases of lupus erythematosus induced by antipdl1 immunotherapy. Druginduced lupus erythematosus also known as dile or dil can occur as a sideeffect of certain medications. Druginduced lupus erythematosus following immunotherapy. T he most frequently evoked theory to explain the pathogenesis of druginduced systemic lupus er ythematosus. Medications such as hydralazine, procainamide, methyldopa, chlorpromazine, quinidine, and minocycline are known to cause sle. Druginduced lupus erythematosus is caused as a side effect to the drugs used for treating some of the chronic diseases. We believe the title of the report and the clinical laboratory features may be misleading. Drugs less frequently associated with the disease are chlorpromazine, isoniazid, methyldopa, penicillamine, quinidine and sulfasalazine. There are no standardized diagnostic criteria for druginduced lupus erythematosus, but in such cases there must have been continuous exposure to a pharmacological trigger for at least a month, with resolution after discontinuation of the drug. The four different types of lupus lupus foundation of. This is similar to the 90 per cent incidence of joint symptoms in sle. The nature of drug induced systemic lupus erythematosus, arthritis rheum 3. Adverse cutaneous drug reactions to cardiovascular drugs.
Subacute cutaneous lupus erythematosus scle is a welldefined subtype of lupus erythematosus, characterised by photosensitivity, annular andor psoriasiform lesions, variable systemic involvement and presence of circulating ssaantiro antibodies. Lupus erythematosus tumidus with pseudolymphomatous. Adverse cutaneous drug reactions are among the most frequent events in patients receiving drug therapy. Druginduced lupus erythematosus with in vivo lupus erythematosus cells in pleural fluid. Druginduced lupus erythematosus is similar but not identical to systemic lupus erythematosus sle. Similarly to idiopathic lupus, dile can be diveded into systemic sle, subacute cutaneous scle and chronic. Drug induced chronic cutaneous le is the rarest of the three forms.
In druginduced lupus erythematosus a specific aha antih2ah2bdna igg is produced, while in most of the other associated diseases except systemic lupus erythematosus and scleroderma the ahas are of other varying specificities. Druginduced lupus is a syndrome resembling mild systemic lupus erythematosus which can complicate treatment with certain apparently unrelated therapies. Males and females have been equally affected, and the mean age of onset has been 59 years. Increased expression of the novel proinflammatory cytokine high mobility group box chromosomal protein 1 in skin lesions of patients with lupus erythematosus. List of systemic lupus erythematosus medications 41. Druginduced systemic lupus erythematosus sle was first reported more than 50 years ago and remains poorly understood despite the 80 or more drugs that can cause a range of autoimmune symptoms.
Systemic lupus erythematosus, often abbreviated sle, is a serious autoimmune syn drome that usually. This is the first reported case in the literature of a druginduced lupusdriven mas. Dile can arise months to years after exposure to drugs prescribed to treat various medical conditions eg, antihypertensives, antibiotic. It tends to affect older patients ages 50 to 70, men more than women and caucasians more than africanamericans. Although the pathogenesis of dil is not well understood, a genetic predisposition may play a role in the case of certain drugs, particularly those agents that are metabolised by acetylation such as procainamide and hydralazine, with disease more likely to. Druginduced subacute cutaneous lupus erythematosus discle is a dile variant with predominant skin involvement, temporally related to drug. The good news is that symptoms tend to go away after the medication is stopped. However, various theories have been developed regarding the pathogenesis of druginduced lupus. Exposure to certain drugs may induce a lupuslike illness or exacerbate sle. While lupus may damage your kidneys or lungs, druginduced lupus rarely affects your. The most common individual agents are procainamide and hydralazine.
Druginduced lupus erythematosus is a lupuslike syndrome induced by an offending agent or drug. There are currently no standard diagnostic criteria for dile and the pathomechanisms are still unclear. Druginduced lupus erythematosus dile is defined as a lupuslike syndrome temporally related to continuous drug exposure which resolves after discontinuation of the offending drug. Druginduced lupus erythematosus associated with donepezil. This phenomenon was first described in 1945 in association with sulfadiazine. Also, druginduced lupus rarely affects major organs. Most often, the disease goes away when the medicine is.
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