scholarly journals Treatment of Discoid Lupus Erythematosus in a Dog with Human Intravenous Immunoglobulin

2021 ◽  
Vol 49 ◽  
Author(s):  
Yujin Choi ◽  
Taesik Yun ◽  
Yoonhoi Koo ◽  
Yeon Chae ◽  
Dohee Lee ◽  
...  
Keyword(s):  
Skin Biopsy ◽  
Intravenous Immunoglobulin ◽  
Lupus Erythematosus ◽  
Skin Disease ◽  
Skin Lesions ◽  
Immunosuppressive Drugs ◽  
Discoid Lupus Erythematosus ◽  
Pemphigus Foliaceus ◽  
Black Crusts ◽  
Human Intravenous Immunoglobulin

Background: Discoid lupus erythematosus (DLE) is a common canine autoimmune skin disease, in which systemic manifestations are absent. Skin Lesions are usually present on the nasal planum, and characterised by erythema, depigmentation, erosion, ulceration, and crusting. The diagnosis is based on histopathological results, which should demonstrate lymphoplasmacytic lichenoid-interface dermatitis. Human intravenous immunoglobulin (hIVIg) has been used in veterinary medicine to treat cutaneous diseases including erythema multiforme, PF, and severe adverse cutaneous drug reactions. In human medicine, it has been effective to treat DLE. This report firstly describes the clinical response to hIVIg in a dog with DLE resistant to common immunosuppressive drugs.Case: A 5-year-old, intact female Shih Tzu presented with a 1-month history of slowly progressive black crusting on the nasal planum, chin, and claw. Based on the results of a dermatologic examination, superficial pyoderma was diagnosed. The skin lesions did not improve during and after anti-infective treatment. After removing the crusts, a skin biopsy was obtained from the muzzle. Histopathology of lesional skin biopsy specimens revealed lymphoplasmacytic interface dermatitis at the dermoepidermal junction. Microscopic examination also revealed vacuolar changes and pigmentary incontinence of the basal layer as a lichenoid tissue reaction. No mites or fungi were detected on the skin section. The absence of acantholytic cells excluded pemphigus foliaceus, which is also characterised by the lesions of the nasal planum. Based on the distribution of the lesions, histopathology and exclusion of other dermatoses, the dog was diagnosed with DLE. The skin lesions temporarily improved after treatment with prednisolone (2 mg/kg PO q12h). However, after tapering the dose of prednisolone, new black crusts developed on the nasal planum and claw. Although the dog was successively treated with other immunosuppressive drugs, including azathioprine, cyclosporin with dexamethasone, and mycophenolate mofetil, black crusts still remained. Due to the low efficacy of these immunosuppressive drugs, hIVIg was administered at 0.5 g/kg once daily for 4 days, for a total dose of 2 g/kg. During hIVIg administration, the crusted lesions gradually improved. After the hIVIg administration, the dog was treated with prednisolone (1 mg/kg PO q12h). The lesions were almost in complete remission at 21 days after an additional application of prednisolone. The skin lesions did not recur, and the treatment was eventually discontinued after 6 weeks of additional prednisolone application.Discussion: The standard treatment of canine DLE includes glucocorticoids, and second-line immunosuppressive drugs, such as azathioprine and cyclosporine, are usually added in cases resistant to steroids. This case suggests that hIVIg may be beneficial as an adjunctive treatment option for canine DLE, especially when the application of standard immunosuppressive drugs is limited due to adverse effects or low efficacy. There is evidence from several studies that the steroid-sparing effect of hIVIg is significant in human patients. In the current case, the effective dose of prednisolone was reduced to 2 mg/kg/day after hIVIg administration, and prednisolone therapy was finally discontinued completely. The hIVIg appears to lower the daily steroid dose requirement in this dog. Keywords: autoimmune skin disease, discoid lupus erythematosus, canine dermatology, immunosuppressive drug, human intravenous immunoglobulin.

scholarly journals Clinical profile of cutaneous manifestations of connective tissue diseases in North-East India

2021 ◽  
Vol 7 (5) ◽  
pp. 702
Author(s):  
Deepa Mala Subba ◽  
Nandakishore Thokchom ◽  
Linda Kongbam ◽  
Erika Salam ◽  
Deepa Yumnam
Keyword(s):  
Connective Tissue ◽  
Lupus Erythematosus ◽  
Cutaneous Lupus Erythematosus ◽  
Connective Tissue Diseases ◽  
Skin Lesions ◽  
Discoid Lupus Erythematosus ◽  
Serological Tests ◽  
Cross Sectional ◽  
Cutaneous Manifestations ◽  
North East

<p class="abstract"><strong>Background:</strong> Connective tissue diseases (CTDs) are a heterogeneous group of autoimmune disorders having overlapping clinical features. Skin is often involved and it may be the earliest sign of the disease. This study highlighted the various cutaneous manifestations of common CTDs.</p><p class="abstract"><strong>Methods:</strong> A hospital-based cross-sectional study was carried out for a period of two years in 83 patients with CTDs in dermatology OPD, RIMS, Imphal. Detailed history taking, examination and relevant serological tests were performed.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean age was 39.78±17.29 years with female to male ratio of 4.5:1. Majority of the patients had lupus erythematosus (LE) (N=45) followed by systemic sclerosis (SSc) (N=25), rheumatoid arthritis (RA) (N=6), mixed connective tissue disease (MCTD) (N=4) and morphea (N=3). The most common presentation was raised skin lesions (45.8%) followed by Raynaud’s phenomenon (36.1%), photosensitivity (27.7%), skin tightness (26.5%) and joint pain (19.3%). Among LE patients, chronic cutaneous lupus erythematosus (CCLE) was the commonest variant and localised discoid lupus erythematosus (DLE) (22.9%) was the commonest presentation followed by malar rash and annular subacute lupus erythematosus (SCLE). Skin induration, microstomia and sclerodactyly were seen in most patients of SSc. Antinuclear antibodies were positive in 89.1% of patients. Anti-dsDNA and anti-Sm antibodies were positive in 62.2% and 33.3% of LE patients, anti-Scl 70 antibody was positive in 68% of SSc patients.</p><p class="abstract"><strong>Conclusions:</strong> CTDs are rare but potentially life-threatening. Proper understanding of the spectrum of cutaneous manifestations of CTDs is therefore necessary for early diagnosis and efficient management.</p>

Treatment of Severe Adverse Cutaneous Drug Reactions With Human Intravenous Immunoglobulin in Two Dogs

2006 ◽  
Vol 42 (4) ◽  
pp. 312-320 ◽  
Author(s):  
Tara K. Trotman ◽  
Heidi Phillips ◽  
Hilary Fordyce ◽  
Lesley G. King ◽  
Daniel O. Morris ◽  
...  
Keyword(s):  
Supportive Care ◽  
Intravenous Immunoglobulin ◽  
Poor Response ◽  
Skin Lesions ◽  
Wound Management ◽  
High Morbidity ◽  
Drug Reactions ◽  
Injectable Drugs ◽  
Cutaneous Drug Reactions ◽  
Human Intravenous Immunoglobulin

Severe adverse cutaneous reactions were documented in two dogs with acute skin lesions and systemic signs after exposure to several oral and injectable drugs. Because of the high morbidity and mortality rates of many severe cutaneous drug reactions and a poor response to supportive care, wound management, and conventional immunosuppressive therapy, human intravenous immunoglobulin (IVIG) was infused on 2 consecutive days (1 g/kg per day) after informed consent was received. Human IVIG, with supportive care, resulted in rapid resolution of dermatological and systemic signs in both dogs; this treatment may be considered in other cases of severe cutaneous drug reactions.

scholarly journals SLICC 2012: Kriteria Klasifikasi SLE

2019 ◽  
Vol 2 (2) ◽  
pp. 48-59
Author(s):  
Prema Hapsari Handayani
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Skin Disease ◽  
Discoid Lupus Erythematosus ◽  
Systemic Lupus ◽  
Neonatal Lupus ◽  
Drug Induced ◽  
Neonatal Lupus Erythematosus

Istilah Lupus diambil dari bahasa latin yang berarti serigala dan dipakai pertama kali pada abad pertengahan untuk menggambarkan lesi kulit yang erosive yang mirip dengan gigitan serigala. Pada tahun 1846 seorang ahli  dari Vienna bernama Ferdinand von Hebra memperkenalkan istilah “kupu-kupu” untuk menggambarkan rash di daerah malar dan menyebutnya sebagai lupus erythematosus . Ilustrasi ini dipublikasikan pertama kali dalam bukunya berjudul Atlas os Skin Disease pada tahun 1856.  Lupus kemudian dibagi menjadi tiga bentuk, yaitu Discoid Lupus Erythematosus,Neonatal Lupus Erythematosus, Drug Induced Lupus dan Systemic Lupus Erythematosus.

scholarly journals Immune-enhancing agents in autoimmune skin diseases – A review

2022 ◽  
Vol 0 ◽  
pp. 1-8
Author(s):  
Abel Francis ◽  
Anjali Rose Jose
Keyword(s):  
Lupus Erythematosus ◽  
Skin Diseases ◽  
Immunosuppressive Drugs ◽  
Squaric Acid ◽  
Discoid Lupus Erythematosus ◽  
Autoimmune Conditions ◽  
Life Threatening ◽  
Autoimmune Dermatoses ◽  
Dibutyl Ester ◽  
Systemic Agents

Immunosuppressive drugs are the main stay of treatment for autoimmune dermatoses. The main disadvantage of these drugs is the increased susceptibility to life-threatening infections. Hence, in recent years, there has been an enthusiastic search for newer groups of drugs that can reduce this risk. Immune enhancing agents are considered as the key players of future. Immune enhancers function by activating various elements of the immune system and thereby amplifying the immune responses. They can be specific or non-specific in action. The main autoimmune dermatoses where the benefits of these drugs have so far been utilized include alopecia areata, vitiligo, psoriasis, lichen planus, and discoid lupus erythematosus. Immunostimulants are available in both topical and systemic forms. Topical immune- enhancing agents include contact sensitizers (diphenylcyclopropenone, dinitrochlorobenzene, and squaric acid dibutyl ester), anthralin, topical zinc, and interferons. Systemic agents include levamisole, zinc, probiotics, and so on. The exact mechanism of action of some of these drugs and other autoimmune conditions where they can be benefited is not completely understood. Another therapeutic agent that may come up in the future is individualized vaccines. Let us look forward to the days when individualized vaccines work wonders in the management of autoimmune diseases.

Paramyxovirus-like Structures in Lupus and Dermatomyositis

1969 ◽  
Vol 27 ◽  
pp. 222-223 ◽  
Author(s):  
Ken Hashimoto
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Skin Lesions ◽  
Collagen Disease ◽  
Discoid Lupus Erythematosus ◽  
Systemic Lupus ◽  
Collagen Diseases ◽  
Identical Structure

Paramyxovirus-like structures in so-called collagen disease have been reported in polymyositis and systemic lupus erythematosus. The identical structure was found in the present study in the skin lesions of discoid lupus erythematosus and dermatomyositis; these two are also called collagen diseases. This report deals with detailed ultrastructure and some aspects of the mode of formation of this structure as they are seen in the skin lesions of discoid lupus and dermatomyositis.

scholarly journals Macrophage activation syndrome in a newborn: report of a case associated with neonatal lupus erythematosus and a summary of the literature

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Veerle Heijstek ◽  
Meelad Habib ◽  
Roel van der Palen ◽  
Remco van Doorn ◽  
Petra Hissink Muller
Keyword(s):  
Skin Biopsy ◽  
Lupus Erythematosus ◽  
Macrophage Activation Syndrome ◽  
Macrophage Activation ◽  
Cutaneous Lupus Erythematosus ◽  
Skin Lesions ◽  
Nuclear Antigen ◽  
Good Effect ◽  
Neonatal Lupus ◽  
Activation Syndrome

Abstract Background Macrophage activation syndrome (MAS) is a life-threatening hyperinflammatory syndrome and is caused by a severely dysregulated immune response. It has rarely been associated with neonatal lupus. Case presentation We present a female neonate with MAS born to a mother who had cutaneous lupus erythematosus with circulating anti-nuclear antibodies (ANA), anti-SSA, anti-SSB and anti-extractable nuclear antigen (anti-ENA) antibodies. Because of neonatal lupus (NLE) with a total atrioventricular block, epicardial pacemaker implantation was required on the sixth day of life. Following surgery she developed non-remitting fever and disseminated erythematous skin lesions. A diagnosis of MAS was made based on these symptoms, with hyperferritinemia, elevated transaminases, hypertriglyceridemia, and a skin biopsy that showed hemophagocytosis. Our patient was treated with steroids for 3 months with good effect. No relapse has occurred. Conclusions MAS is a rare complication of neonatal lupus that may be difficult to diagnose, but needs to be treated promptly. In this article, pathogenesis and overlap of MAS and hemophagocytic lymphohistiocytosis (HLH) has been described. Diagnosis of MAS can be difficult. Different diagnostic criteria are used in both diagnosing MAS and HLH. Validated criteria for diagnosis of MAS in other disease than systemic onset JIA have not been validated yet. In NLE, diagnosing MAS is even more difficult, since skin lesions are already common in NLE. We show the potential additional value of skin biopsy in diagnosing MAS.

scholarly journals Rowell syndrome – a clinical entity that must not be forgotten

2016 ◽  
Vol 63 (4) ◽  
pp. 331-333
Author(s):  
Maria Daniela Tănăsescu ◽  
◽  
Mihai Ovidiu Comşa ◽  
Alexandru Mincă ◽  
Alexandru Cristian Diaconescu ◽  
...  
Keyword(s):  
Erythema Multiforme ◽  
Lupus Erythematosus ◽  
Rare Condition ◽  
Skin Lesions ◽  
Pulse Therapy ◽  
Therapeutic Regimen ◽  
Discoid Lupus Erythematosus ◽  
Cutaneous Lesions ◽  
High Doses ◽  
Minor Criteria

Objective. Rowell Syndrome represents a rare condition, characterised by the existence of erythema multiforme with lupus erythematosus. The diagnosis is made in patients which present both the major criteria (coexistence of discoid lupus erythematosus with erythema multiforme lesions and positivity for speckled - pattern antinuclear antibodies) and at least one of the minor criteria (frostbites-like lesions, positive anti-La or anti-Ro antibodies and reactive rheumatoid factor). The main objective of this article is to evidence a rare case of Rowell Syndrome and the optimal diagnostic and therapeutic management involved for resolving this case. Material and method. This article presents the case of a 47-year-old patient diagnosed with Rowell Syndrome, which met the diagnostic criteria. In her case, we used a therapeutic regimen comprising Hydroxychloroquine 400 mg/day and pulse-therapy with methylprednisolone 1 gram/day, for 3 days. Results. The decremental titration of prednisone resulted in reoccurrence of cutaneous lesions, prompting the return to the high doses, with normalisation of skin lesions. Conclusions. The presented case highlights the importance of keeping in mind the diagnosis of Rowell Syndrome in all the situations of patients with serologic profile of lupus and erythema multiforme lesions. Discussion. The therapeutic regimen and evolution under treatment may have a variable course, imposing the monitoring of patients a course for preventing the disease relapse.

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