Drug-induced lupus erythematosus

Vedove, Camilla Dalle; Giglio, Micol Del; Schena, Donatella; Girolomoni, Giampiero

doi:10.1007/s00403-008-0895-5

Cited by 256 publications

(200 citation statements)

References 38 publications

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“…The typical features of systemic DIL are mild SLE manifestations with positive ANA and anti-histone antibodies temporally related to drug exposure which typically resolves after discontinuation of the offending drug. 8,13 Despite the presence of anti-histones our patient had polyarthritis, anti-dsDNA and hypocomplementemia which play against the possibility of DIL. In addition, more than a year after the withdrawal of mefenamic acid the patient maintained these clinical and laboratory features.…”

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confidence: 75%

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Anaphylaxis to mefenamic acid in a patient with new onset of systemic lupus erythematosus

Couto

Duarte

Geraldes

et al. 2010

Allergologia et Immunopathologia

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Many studies have addressed the frequency of drug allergy (DA) in systemic lupus erythematosus (SLE) patients. Some studies suggest that there may be an increased risk in these patients 1-4 while others do not confirm this. [5][6][7] The conflicting results may be due to differences in definition of drug allergy; in the means of ascertaining allergic manifestations; and in the choice of controls. SLE patients are more frequently exposed to drugs, which, ''per se'', represent a risk factor for drug allergy. Prompt recognition of DA, particularly anaphylaxis, is crucial, as it may be life-threatening and the appropriate treatment cannot be delayed. In a patient with SLE, the differential diagnosis of drug allergy is challenging. Features such as rash, fever and cytopenia may result from drug allergy but may also be part of SLE manifestations. Furthermore, drugs like sulphonamides are well known to exacerbate, or even induce SLE. 8,9 The authors report a case of a 32-year-old Caucasian female housewife who presented at the emergency room with rash, diffuse myalgias, dry mouth, paraesthesia and dizziness. The symptoms started 90 minutes after taking a 250 mg tablet of mefenamic acid. She was thought to have an allergic drug reaction and was treated with intramuscular clemastin and IV methylprednisolone 250 mg. She was alert, her blood pressure was 100/57 mmHg, her heart rate was 124 per minute and her temperature was normal. Despite receiving clemastin and methylprednisolone, two hours later she had a clinical deterioration starting with generalised pruritus and worsening of generalised exanthema, myalgias and arthralgias. She rapidly developed angio-oedema and anaphylactic shock. Her temperature was 37.4 1C, her blood pressure dropped to 73/45 mmHg and her heart rate was 120 per min. She was given dopamine, epinephrine and 250 mg of IV methylprednisolone and intravenous fluids. Blood cell count revealed a haemoglobin level of 7.9 g/dl [11.5-16.5 . Chest x-ray and ECG were normal. She was diagnosed with DA to mefenamic acid and acute hepatic failure and was admitted into the Intensive Care Unit.In the Intensive Care Unit, life support care was maintained and she started prednisolone 1 mg/Kg/day and topical silver sulphadiazine for skin lesions. By the third day she was haemodynamically stable, her liver function was almost normal and the skin lesions were resolving.This patient had a history of new onset of polyarthralgia three weeks previous to this episode which was treated by her general practitioner with mefenamic acid 250 mg tablets bid. One week later, she had not improved and cyclobenzaprine 10 mg qd was added to her treatment. She stopped both drugs the following day because of malaise and facial exanthema that resolved completely. She did not take any other medications except for chronic treatment with thyroxine for hypotiroidism. Laboratory tests done by her general practitioner 11 days before this episode showed an anti-nuclear antibody ( Lymphoblastic proliferation test to mefenamic acid was negative. Dr...

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confidence: 75%

“…The strongest evidence of causality is for procainamide, hydralazine and isoniazid. 8,13 Drugs such as anti-hypertensives, antibiotics and anti-convulsivants are of low risk. 8 Among NSAID only celecoxib 14 has been implicated in DIL and there are no published case reports for mefenamic acid.…”

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confidence: 99%

Anaphylaxis to mefenamic acid in a patient with new onset of systemic lupus erythematosus

Couto

Duarte

Geraldes

et al. 2010

Allergologia et Immunopathologia

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“…In addition, eosinophilia with pleural exudative effusion induced by the administration of isoniazid has been reported (12). Isoniazid (INH) is one of over 80 medications implicated in the onset of drug-induced lupus erythematosus (DILE), a lupus-like syndrome temporally related to continuous drug exposure that resolves after the cessation of the offending pharmacologic agent (13). Although a wide range of isoniazid-induced side effects have been reported, most adverse reactions do not affect the course of treatment.…”

Section: Discussionmentioning

confidence: 99%

Isoniazid-induced Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Presenting as Acute Eosinophilic Myocarditis

Zhang

Yang

et al. 2015

Intern. Med.

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It has been reported that hypereosinophilic syndrome may be induced by antituberculosis drugs. We herein report the case of a 43-year-old man who had been on antituberculosis drugs for two months to treat tuberculous meningitis. During therapy, he suffered from drug rash with eosinophilia and systemic symptoms (DRESS) presenting as acute eosinophilic myocarditis, as confirmed on a histopathologic examination. According to the patient's medication history, clinical features and accessory examination findings, the eosinophilic myocarditis was thought to be possibly induced by isoniazid. Although further investigations are needed to confirm causality, isoniazid may be added to the list of drugs with the potential to cause DRESS syndrome.

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“…Nonetheless, with the mitogenic stimulation, higher expression levels of IFN-γ were detected from mononuclear cells in peripheral blood of lupus patients than controls [20]. It is very interesting to find that some patients would suffer from severe lupus-like disease, if they were treated with IFN-γ for unrelated autoimmune diseases [21,22].…”

Section: Ifn-γ and Its Regulatory Roles In Slementioning

confidence: 99%

Biological Features of IL-12 and IFN-? in the Pathogenesis of Systematic Lupus Erythematosus

Lu¹,

Wang²,

Wang³

et al. 2017

J Clin Exp Pathol

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Systemic lupus erythmatosus is a chronic autoimmune disease characterized by abnormal immune response with overproduction of auto-antibodies, self-destructive complexes and hyperactivity of both T and B lymphocytes. Although the exact pathogenesis of SLE remains unclear, it has been found that the imbalance of Th1/Th2, subsequent cytokines and anti-or pro-inflammatory mediators could reflect the stage and phenotype of SLE. Among diverse cytokines involved in the disease progression, IL-12 and IFN-γ gain much attention for their biological functions in SLE. There existed many divergences on the expression level of IL-12 while few conflicts were demonstrated on elevated level of IFN-γ in SLE patients. By analysis of gene polymorphisms, it was suggested that positive correlations were observed between IL-12B rs3212227, IL-12B rs17860508 and susceptibility to and severity of SLE in Polish patients. In addition, the combination of the IL-12B rs17860508 GC allele and/or IL-12B rs3212227 C allele could increase the risk of SLE progression and/or severity of SLE parameters in Polish population. Furthermore, it was also found that the incorporation of IFN-γ R 1 Met 14/Val 14 and IFN-γ R 2 Gln 64/Gln 64 genotypes was a potential risk factor for SLE. Based on the previous researches, IL-12 and IFN-γ targeted gene therapy was developed and found to be effective in murine lupus. Intramuscular injection of IFN-γR/IgG1Fc fusion protein encoded cDNA and suppressive ODN was found to decrease the severity of disease and promote survival of lupus mice. On the other hand, intramuscular injection of IL-12 and IL-18 encoded plasmids alone or together was also observed to have therapeutic effects on murine lupus. All in all, this review mainly introduces the biological features and the potential therapeutic effects of IL-12 and IFN-γ in the pathogenesis of SLE.

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Drug-induced lupus erythematosus

Cited by 256 publications

References 38 publications

Anaphylaxis to mefenamic acid in a patient with new onset of systemic lupus erythematosus

Anaphylaxis to mefenamic acid in a patient with new onset of systemic lupus erythematosus

Isoniazid-induced Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Presenting as Acute Eosinophilic Myocarditis

Biological Features of IL-12 and IFN-? in the Pathogenesis of Systematic Lupus Erythematosus

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