The devil's in the dosing: severe drug-induced liver injury in a hydroxychloroquine-naive patient with subacute cutaneous lupus erythematosus and porphyria cutanea tarda

Lupus ◽  
2018 ◽  
Vol 27 (8) ◽  
pp. 1383-1386 ◽  
Author(s):  
B Sunkara ◽  
D Roofeh ◽  
S Silver ◽  
T LeBleu Pearson ◽  
M Ettel ◽  
...  
Keyword(s):  
Liver Injury ◽  
Lupus Erythematosus ◽  
Porphyria Cutanea Tarda ◽  
Cutaneous Lupus Erythematosus ◽  
Antibody Test ◽  
Skin Lesions ◽  
Drug Induced ◽  
Naive Patient ◽  
Drug Induced Liver Injury ◽  
Cutaneous Lupus

A 29-year-old woman with a 1.5 year history of photosensitive skin lesions on her hands presented with a malar rash, bullous lesions on her hands, and was diagnosed with subacute lupus erythematosus after serologies revealed a positive antinuclear antibody test (1:2560), and antibodies to Ro/SSA and dsDNA. Hydroxychloroquine (400 mg/day) was prescribed and the patient developed severe drug-induced liver injury. Biopsy of her bullous skin lesions was consistent with porphyria cutanea tarda, as were her serological and urinary exams. She was successfully treated with therapeutic phlebotomy. This case identifies porphyria cutanea tarda as an important differential diagnosis for the rheumatologist to consider when evaluating patients with bullous skin lesions. Hydroxychloroquine in lower doses is an effective treatment for porphyria cutanea tarda; at doses used to treat systemic lupus erythematosus and subacute cutaneous lupus, there is a potentially life-threatening complication of hepatotoxicity.

Subacute Cutaneous Lupus Erythematosus Induced by Nifedipine

2003 ◽  
Vol 7 (3) ◽  
pp. 243-246 ◽  
Author(s):  
Emanuela Gubinelli ◽  
Barbara Cocuroccia ◽  
Giampiero Girolomoni
Keyword(s):  
Lupus Erythematosus ◽  
Cutaneous Lupus Erythematosus ◽  
Skin Lesions ◽  
Channel Blockers ◽  
Subacute Cutaneous Lupus Erythematosus ◽  
Rapid Improvement ◽  
Drug Induced ◽  
Dermoepidermal Junction ◽  
Antihistone Antibody ◽  
Cutaneous Lupus

Background: Subacute cutaneous lupus erythematosus (SCLE) has been reported to be associated with the use of several drugs, including thiazides, terbinafine, and, rarely, calcium channel blockers. Objective: A case of SCLE induced by nifedipine is presented. Methods and Results: A 48-year-old white woman developed a papulosquamous and annular eruption in sun-exposed areas during the summer. The patient was taking nifedipine for essential hypertension for four years. Serology showed the presence of antinuclear and anti-Ro/SSA as well as antihistone antibodies. Histopathologic and immunopathologic (granular IgM deposits at the dermoepidermal junction) findings confirmed the diagnosis of SCLE. Nifedipine discontinuation led to rapid improvement with almost complete resolution of skin lesions in one month in the absence of active treatment. Reduction of antinuclear, anti-Ro/SSA, and antihistone antibody levels was documented after six months. Conclusion: Nifedipine can cause SCLE after a long period of administration. Antihistone antibodies may be associated with drug-induced SCLE.

scholarly journals THU0010 GENES ASSOCIATED WITH NUCLEOTIDE OLIGOMERIZATION DOMAIN-LIKE RECEPTOR SIGNALING PATHWAY ARE UPREGULATED IN CUTANEOUS LUPUS ERYTHEMATOSUS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 217.3-217
Author(s):  
I. Calderon ◽  
R. Mina
Keyword(s):  
Immune System ◽  
Signaling Pathway ◽  
Lupus Erythematosus ◽  
Innate Immune System ◽  
Cutaneous Lupus Erythematosus ◽  
Skin Lesions ◽  
Innate Immune ◽  
Normal Controls ◽  
Cutaneous Lupus ◽  
Skin Samples

Background:Cutaneous Lupus Erythematosus (CLE) is a disfiguring autoimmune skin disorder with several subtypes: discoid lupus, subacute cutaneous lupus, and acute cutaneous lupus. CLE is associated with defects in the adaptive immune system, and, at times, systemic involvement. The innate immune system is likely involved as seen in the presence of interface dermatitis, which is observed in viral exanthems, and improvement of CLE using inhibitors to membrane-bound Pattern Recognition Receptors.Objectives:Compare the expression of genes associated with the innate immune system in active CLE skin lesions of different subtypes compared to normal skin controls.Methods:Five datasets selected from the Gene Expression Omnibus (GEO) were analyzed using GEO2R to compare the gene expressions between different subtypes of CLE. Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database, Gene Card, and Kyoto Encyclopedia of Genes and Genomes (KEGG) Pathway analysis were used to identify the interaction and function of specific genes.Results:There were a total of 147 CLE skin samples and 52 normal controls. Genes associated with the Nucleotide-Binding Oligomerization Domain-Like Receptor (NLR) signaling pathway were upregulated in CLE skin samples (adjusted p-value < 0.001). Five genes associated with the NLR signaling pathway, STAT1, OAS1, OAS2, OAS3, and AIM2, were found to be upregulated in skin samples of CLE patients in all datasets, regardless of type, compared to normal controls in all datasets. These five genes are associated with transcription activation, regulation of viral infection, and interferon response.Conclusion:Genes associated with the NLR signaling pathway are upregulated in the skin lesions of CLE patients compared to normal controls, supporting the role of the innate immune system in CLE. Further validation studies using experimental methods are needed.References:[1]Enhanced inflammasome activity in systemic lupus erythematosus is mediated via type I interferon upregulation of interferon regulatory factor 1. Liu J, et al. Arth Rheum. 2017; 69(9): 1840-1849.Disclosure of Interests:None declared

scholarly journals Drug-induced subacute cutaneous lupus erythematosus caused by amlodipine

2018 ◽  
Vol 105 (2) ◽  
pp. 298-306
Author(s):  
Agata Kozłowska ◽  
Zdzisław Woźniak ◽  
Joanna Maj ◽  
Rafał Białynicki-Birula
Keyword(s):  
Lupus Erythematosus ◽  
Cutaneous Lupus Erythematosus ◽  
Subacute Cutaneous Lupus Erythematosus ◽  
Drug Induced ◽  
Cutaneous Lupus

scholarly journals Subacute cutaneous lupus erythematosus with a possible paraneoplastic association with melanoma

2019 ◽  
Vol 12 (11) ◽  
pp. e230558 ◽  
Author(s):  
Jesse Hirner
Keyword(s):  
Proton Pump Inhibitor ◽  
Lupus Erythematosus ◽  
Cutaneous Lupus Erythematosus ◽  
Laboratory Evaluation ◽  
Topical Steroids ◽  
Subacute Cutaneous Lupus Erythematosus ◽  
Drug Induced ◽  
Dermatology Clinic ◽  
Common Causes ◽  
Cutaneous Lupus

A 52-year-old man was referred to our dermatology clinic for a diagnosis of melanoma. At the time, his melanoma was excised he developed an annular, polycyclic, scaling eruption consistent with subacute cutaneous lupus erythematosus (SCLE). Skin biopsy and laboratory evaluation confirmed this diagnosis. The patient had been using pantoprazole for gastro-oesophageal reflux disease for the last 3 years. The patient’s melanoma was treated surgically, and his SCLE was treated with topical steroids and hydroxychloroquine. His SCLE cleared rapidly, his steroids and hydroxychloroquine were stopped and he remains free of SCLE off of treatment. The parallel course of the patient’s SCLE and melanoma prompted consideration of SCLE as paraneoplastic to melanoma in this case. The clinical picture was complicated by the patient’s use of a proton pump inhibitor, which are common causes of drug-induced SCLE. To our knowledge, this is the first reported case of possible paraneoplastic SCLE associated with melanoma.

The study of Cutaneous Lupus Erythematosus Disease Area and Severity Index in Indian patients with systemic lupus erythematosus

Lupus ◽  
2011 ◽  
Vol 20 (14) ◽  
pp. 1510-1517 ◽  
Author(s):  
P Salphale ◽  
D Danda ◽  
L Chandrashekar ◽  
D Peter ◽  
N Jayaseeli ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Cutaneous Lupus Erythematosus ◽  
Severity Index ◽  
Skin Lesions ◽  
Systemic Lupus ◽  
Disease Area ◽  
Indian Patients ◽  
The Mean ◽  
Cutaneous Lupus

The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) is a newly described tool used to assess the activity of and damage caused by cutaneous lupus erythematosus (CLE). There is a paucity of data on CLASI from the Indian subcontinent. We sought to determine the applicability of CLASI in specific lesions of CLE in patients with systemic lupus erythematosus (SLE) attending a tertiary care hospital in India. In this prospective, cross-sectional study, 93 patients of SLE with cutaneous lesions were recruited. CLASI activity and damage scores of lupus erythematosus (LE)-specific skin lesions were done in 75 patients with SLE. The mean CLASI activity score was 15.4 ± 9.4 (range 0–39) and the mean damage score was 6.87 ± 7.75 (range 0–30). Higher mean CLASI activity scores were seen in patients with a combination of acute, subacute and chronic CLE and in those with widespread lesions. Patients with longstanding disease and long duration of skin lesions had higher damage scores. This study shows that CLASI is an effective tool to assess cutaneous activity of LE-specific lesions, and the damage caused by them, in Indian patients.

scholarly journals Low number of regulatory T cells in skin lesions of patients with cutaneous lupus erythematosus

2007 ◽  
Vol 56 (6) ◽  
pp. 1910-1920 ◽  
Author(s):  
B. Franz ◽  
B. Fritzsching ◽  
A. Riehl ◽  
N. Oberle ◽  
C.-D. Klemke ◽  
...  
Keyword(s):  
T Cells ◽  
Regulatory T Cells ◽  
Lupus Erythematosus ◽  
Cutaneous Lupus Erythematosus ◽  
Skin Lesions ◽  
Cutaneous Lupus
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