RESEARCH - Drug-induced lupus erythematosus

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Arch Dermatol Res. 2009 Jan;301(1):99-105. Epub 2008 Sep 17.

Drug-induced lupus erythematosus.

Vedove CD, Del Giglio M, Schena D, Girolomoni G.

Section of Dermatology and Venereology, Department of Biomedical and

Surgical Sciences, University of Verona, Piazzale A. Stefani 1, 37126,

Verona, Italy.

Drug-induced lupus erythematosus (DILE) is defined as a lupus-like

syndrome temporally related to continuous drug exposure which resolves

after discontinuation of the offending 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 profile with positive antinuclear and anti-histone

antibodies, while anti-double strand (ds) DNA and anti-extractable

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,

angiotensin-converting enzyme inhibitors, interferons, thiazide

diuretics and terbinafine. Drug-induced CCLE is very rarely reported

in the literature and usually refers to fluorouracile agents or non

steroidal anti-inflammatory drugs. Recently, cases of DILE have been

reported with anti-TNFalpha agents. These cases present with disparate

clinical features including arthritis/arthralgia, skin rash,

serositis, cytopenia and variable laboratory abnormalities. DILE to

anti-TNFalpha agents differs 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-TNFalpha 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-TNFalpha DILE; in contrast, anti-histone antibodies

are described in classic DILE more often than in anti-TNFalpha DILE.

Recognition of DILE in patients receiving anti-TNFalpha therapy can be

difficult due to the symptoms of their underlying disease. A temporal

association (months to years) of the offending drug with

characteristic or suggestive symptoms, and resolution of symptoms on

drug withdrawal is the best evidence for this diagnosis of DILE.

PMID: 18797892

http://www.ncbi.nlm.nih.gov/pubmed/18797892

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