An Adolescent Female Presenting with Classical Clinical and Immunological Features of Isoniazid Induced Lupus

Drug induced Lupus Erythematosus (DILE) is a form of rare adverse drug reaction caused due to many drugs, including Isoniazid. Diagnosis is made on the basis of a temporal relationship between the drug administered and the onset of symptoms and on the basis of the antibody profile. We describe the case of a 13 year old female who was diagnosed as having abdominal tuberculosis and was put on ATT and later presented with signs and symptoms of Lupus Erythematosus, with a history of photosensitivity, oral ulcers, and malar rash. Keywords: Isoniazid, Tuberculosis, Drug Induced Lupus

Literature Analysis of 31 Cases of Drug-induced Lupus Induced by Infliximab / 中国药房

OBJECTIVE:To analyze the general patterns and characteristics of drug-induced lupus (DIL) induced by inflix-imab,and to provide reference for the safety of drug use. METHODS:Usinginfiximab,lupusas searching words,inflix-imab-induced DIL literatures included in CJFD,VIP and PubMed from Jan. 2002 to Jun. 2016 were retrieved and analyzed. RE-SULTS:Totally 30 effective literatures were retrieved,involving 31 DIL patients,there were 8 male cases (25.81%) and 23 fe-male cases(74.19%);17 patients aged more than 50(54.84%). 20 cases occurred within 5-24 weeks(64.51%). 16 patients re-ceived infliximab alone (51.61%). Main clinical manifestations were skin rash or photosensitivie enteritig (15 cases),joint pain (16 cases,multiple arthritis and synovitis)and fever(12 cases). 5 patients suffered from 3 above symptoms simultaneously. Labo-ratory examination mainly manifested as antinuclear antibody,double stranded DNA antibody and anti-histone antibody positive. Thirty patients with DIL received drug withdrawal or steroid hormones treatment,among which the symptoms of 26 patients disap-peared after drug withdrawal or treatment within 6 months,and 1 patient deteriorated. CONCLUSIONS:DIL-induced by inflix-imab invovle patients'age and gender,disease types,family history and other factors. Clinicians should be aware of rules and char-acteristics of DIL induced by infliximab,and tighten drug use monitoring to reduce ADR.

Clinical analysis of 6 patients with drug-induced lupus / 中华内科杂志

Objective To improve the understanding of drug-induced lupus (DIL) and the differences from systemic lupus erythematosus (SLE).Methods Clinical manifestation and treatment of patients with definite DIL were retrospectively analyzed.Results Six patients with DIL were enrolled in this study,including 4 females and 2 males.Two patients were diagnosed after receiving interferon,one after soluble tumor necrosis factor receptor fusion protein,one after propylthiouracil,one after penicillamine,and one after levofloxacin.High titer of antinuclear antibody was identified in all six patients,including 3 with positive anti-dsDNA antibody.One patient had positive anti-Sm antibody.One patient had positive anti-RNP antibody.One patient had anti-nucleosome antibody.One patient had anti-histone antibody.One patient had antimitochondrial antibodies-M2,and one patient had anticardiolipin antibodies.Conclusion Patients with DIL are not as severe as those with SLE.After cessation of suspected drugs and administration of standard treatment,the clinical outcome of DIL is satisfying.

Adalimumab-induced Lupus Erythematosus Profundus in a Rheumatoid Arthritis Patient / 대한피부과학회지

The clinical manifestations and immunohistologic findings of drug-induced lupus erythematosus (DILE) are similar to those of idiopathic lupus. However, DILE is different from idiopathic lupus because it is induced after continuous drug exposure and resolves after discontinuation of the causative drug. DILE can be divided into systemic lupus erythematosus, subacute cutaneous lupus erythematosus, and chronic cutaneous lupus erythematosus (CCLE). Lupus erythematosus profundus is a subtype of CCLE, and drug-induced CCLE is very rarely reported in the literature. Herein, we report a rare case of adalimumab-induced lupus erythematosus profundus developed in a rheumatoid arthritis patient. The patient is a 43-year-old Korean woman who had multiple tender nodules and plaques on her face, trunk, and both extremities after using adalimumab for rheumatoid arthritis. She was diagnosed with adalimumab-induced lupus erythematosus profundus, and her condition improved after discontinuation of adalimumab.

Adalimumab-induced Lupus Erythematosus Profundus in a Rheumatoid Arthritis Patient / 대한피부과학회지

The clinical manifestations and immunohistologic findings of drug-induced lupus erythematosus (DILE) are similar to those of idiopathic lupus. However, DILE is different from idiopathic lupus because it is induced after continuous drug exposure and resolves after discontinuation of the causative drug. DILE can be divided into systemic lupus erythematosus, subacute cutaneous lupus erythematosus, and chronic cutaneous lupus erythematosus (CCLE). Lupus erythematosus profundus is a subtype of CCLE, and drug-induced CCLE is very rarely reported in the literature. Herein, we report a rare case of adalimumab-induced lupus erythematosus profundus developed in a rheumatoid arthritis patient. The patient is a 43-year-old Korean woman who had multiple tender nodules and plaques on her face, trunk, and both extremities after using adalimumab for rheumatoid arthritis. She was diagnosed with adalimumab-induced lupus erythematosus profundus, and her condition improved after discontinuation of adalimumab.

Methimazole-Induced Bullous Systemic Lupus Erythematosus: A Case Report

Bullous systemic lupus erythematosus (SLE) is a kind of LE-non-specific bullous skin disease that is rarely induced by a medication. We describe the first case of bullous SLE to develop after administration of methimazole. A 31-yr-old woman presented with generalized erythematous patches, multiple bullae, arthralgia, fever, conjunctivitis, and hemolytic anemia. Biopsy of her bulla showed linear deposition of lgG, lgA, C3, fibrinogen, and C1q at dermo-epidermal junction. She was diagnosed as bullous SLE and treated with prednisolone, dapsone, hydroxychloroquine, and methotrexate. Our experience suggests that SLE should be considered as a differential diagnosis when bullous skin lesions develop in patients being treated for hyperthyroidism.

A Case of Docetaxel Induced Subacute Cutaneous Lupus Erythematosus / 결핵및호흡기질환

Drug-induced subacute cutaneous lupus erythematosus (SCLE) is associated with use of the following classes of medications: anti-hypertensives, anti-cholesterolemia, anti-psychotics, and anti-inflammatory drugs. Docetaxel is an anti-neoplastic agent, which is widely used for treatment of non-small cell lung cancer. Few cases of docetaxel-induced SCLE have been reported in the medical literature. Here, we report the case of a 58-year-old female patient who developed drug-induced SCLE after administration of docetaxel. After 4 cycles of chemotherapy with docetaxel and cisplatin, erythematous skin eruptions developed on the patient's face. Skin biopsies of the eruptions were remarkable for interfacing dermatitis with basement membrane thickening. Immunofluorescent study revealed characteristic features of SCLE, including granular deposition of IgM, C3, and apoptotic bodies along the basement membrane. The skin eruptions resolved gradually after cessation of drug and with the use of topical corticosteroids.

Lúpus induzido por drogas: da imunologia básica à aplicada: [revisão] / Drug-induced lupus: from basic to spplied immunology: [review]

O lúpus induzido por drogas (LID) é descrito como o desenvolvimento de sintomas semelhantes ao do lúpus eritematoso sistêmico idiopático, temporalmente relacionado à exposição a drogas, havendo, comumente, a resolução do quadro com a suspensão do medicamento desencadeante. A associação mais clássica é feita com a procainamida e a hidralazina. Recentemente, com a introdução de novas drogas na prática clínica, tem sido relatado um aumento no número de medicamentos implicados como causadores da doença, e a lista atual inclui quase uma centena de drogas relacionadas à ocorrência de LID. Embora descrito há mais de 60 anos, o mecanismo imunológico básico do LID ainda não está totalmente compreendido. Há várias hipóteses para o processo de indução de auto-imunidade pelas drogas, e o fenômeno geralmente é interpretado como uma inapropriada ativação do sistema imunitário. Entre as diversas teorias propostas, as mais aceitas são: a inibição da metilação do ácido desoxirribonucléico (DNA) por algumas drogas, o que permitiria a ativação das células T; a oxidação de certas substâncias pelos monócitos, gerando metabólitos ativos que ocasionariam ativação das células apresentadoras de antígenos e/ou a interferência dos metabólitos de determinadas drogas com a tolerância do sistema imune. Novos estudos são necessários para a melhor compreensão da imunopatogenia do LID, objetivando desenvolver tratamentos específicos com base no melhor conhecimento dos mecanismos patogênicos.

Drug-induced lupus (DIL) has been described as the development of idiopathic systemic lupus erythematous-like symptoms, temporarily associated to the exposition to drugs, and as a rule, the condition is improved with the suspension of the triggering medication. The most classical association is with procainamide and hydralazine. Recently, with the introduction of new drugs in the clinical practice, an increase on the number of medications associated with the occurence of the disease has been reported, and the current list includes almost one hundred drugs associated to the occurrence of DIL. The basic DIL immunologic mechanism, although described for more than 60 years, is not yet fully understood. There are several hypotheses for the drug-induced autoimmunity process, and the phenomenon is generally interpreted as an inappropriate activation of the immune system. Among the several theories proposed, the most accepted ones are: the inhibition of the DNA methylation by some drugs, what would allow the activation of T-cells; the oxidation of some substances by monocytes, what would generate active metabolites that in turn would lead to the activation of antigen-presenting cells and/or the interference of the metabolites of some drugs with the immune system tolerance. Further studies should be conducted in order to elucidate the DIL immunopathogeny with the objective of developing specific treatments based on the better knowledge on the pathogenic mechanisms.

A Case of Propylthiouracil-induced Lupus Erythematosus / 대한피부과학회지

A 14-year-old girl had a history of Graves' disease and received propylthiouracil (PTU) treatment for 2 years before admission to our hospital. She developed skin rash over her, whole body 1 month before admission, and laboratory examination revealed pancytopenia. Positive antinuclear antibodies, antihistone antibodies and reduced complement levels were noted, although anti-double-stranded DNA and anti-Sm antibodies were negative. A biopsy specimen revealed mild epidermal atrophy and peri-adnexal lymphoid cell infiltration. Linear deposition of IgM along the basement membrane zone was noted by direct immunofluorescence array. After discontinuation of PTU and steroid treatment, eruptions and pancytopenia improved, suggesting drug-induced lupus erythematosus.

A Case of Doxifluridine-Induced Ro/SSA-Positive Cutaneous Lupus Erythematosus / 대한피부과학회지

Anti-Ro/SSA antibody positive drug-induced lupus erythematosus is characterized by erythematous papules at the photodistributed area after drug intake, positive anti-Ro/SSA antibody tests and histopathologic features of lupus erythematosus. A 68-year-old man was referred to our clinic with multiple erythematous violacious plaques on the face of 2 months' duration. After surgical removal of stomach cancer, he had been taking doxifluridine for 10 months. A histopathologic study revealed findings consistent with lupus erythematosus and the anti-Ro/SSA antibody was positive on the serologic test. Based on these findings, we diagnosed this case as anti-Ro/SSA antibody positive drug-induced lupus erythematosus, and report it with review of the literature.

Antinuclear Antibodies in Patients on Medication with Anticonvulsants / 대한류마티스학회지

OBJECTIVE: This study set out to determine the antinuclear antibody (ANA) frequency and fluorescence pattern, as well as the incidence of drug-induced lupus (DIL) in patients on long term medications with anticonvulsants. METHODS: Sera from 200 patients on medications with anticonvulsants for at least 6 months and from 105 healthy controls were tested by indirect immunofluorescence on immunotype (IT)-1 cells, and the medical records were retrospectively reviewed. The patients included 72 on valproic acid, 24 on phenytoin, 75 on carbamazepine, and 29 patients on two or more anticonvulsants. RESULTS: ANA were positive in 3 of the 105 normal controls (3%). Twenty nine percent of patients on valproic acid, 26% on phenytoin, 8% on carbamazepine, and 34% on two or more different anticonvulsants were positive for ANA. The cytoskeletal pattern was prominent in patients on valproic acid and the speckled pattern in phenytoin. Most were of low titers. CONCLUSION: Long-term ingestion of valproic acid and phenytoin were shown to influence ANA, while carbamazepine was not. No definite relationship was observed between ANA positivity and DIL. However, positive ANA indicates effects of anticonvulsants on the immune system, and therefore progression to DIL cannot be ruled out. Therefore, patients on long-term medications with anticonvulsants should be regularly tested for ANA.

Antinuclear Antibodies in Patients on Medication with Cardiovascular Drugs and Antihyperglycemic Agents / 임상검사와정도관리

BACKGROUND: This study was set to determine the antinuclear antibody (ANA) frequency and fluorescence pattern, as well as the incidence of drug-induced lupus (DIL) in patients on long term medications with cardiovascular drugs and antihyperglycemic agents. METHODS: Sera from 301 patients on medications with cardiovascular drugs or antihyperglycemic agents for at least 6 months and 105 serum samples from healthy controls were tested by indirect immunofluorescence on immunotype (IT)-1 cells, and the medical records were retrospectively reviewed. The patients included 39 on digoxin, 38 on theophylline, 8 on theophylline and digoxin, 26 on captopril, 15 on diltiazem, and 182 on antihyperlycemic agents. RESULTS: ANA was positive in 3 of the 105 normal controls (3%). Thirty four percent of patients on medication with digoxin, 29% on theophylline, 31% on captopril, 7% on diltiazem, and 8% on antihyperglycemic agents were positive for ANA. The prominent ANA pattern was cytoplasmic type in patients on digoxin and theophylline, and the speckled type in captopril, however, most of them showed low titers. CONCLUSIONS: Long-term ingestion of theophylline, digoxin, captopril were shown to influence ANA, but not for diltiazem and antihyperglycemics. Therefore, patients on long-term medications with theophylline, digoxin, captopril should be regularly tested for ANA.

A Case of Propylthiouracil-Induced Lupus / 대한류마티스학회지

Propylthiouracil(PTU) is one of lupus-inducing drugs, though rarely reported. We report a case of PTU-induced lupus, with the review of of previous literatures. Lupus-like symptoms in a 28year-old female patient, who had been suffering from relapsed Graves' disease, were presented during PTU therapy. The results of antinuclear antibody and anti-histone antibody were positive. After symptomatic reatment and discontinuation of PTU, all of the symptoms and the abnormalities in laboratory tests disappeared, which suggested drug-induced lupus.