Erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis associated with lupus erythematosus

Torchia, Daniele; Romanelli, Paolo; Kerdel, Francisco A.

doi:10.1016/j.jaad.2011.10.012

Cited by 74 publications

(68 citation statements)

References 10 publications

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“…9,11,12 More recently, Rowell syndrome diagnostic criteria have been revised to clarify Rowell syndrome from other variants of LE and erythema multiforme (Table 3). 13 Similar to the 4 cases of TEN-like LE in adults presented by Ziemer et al, 14 our cases demonstrated clinical features of LE that led us to this diagnosis. All of our patients had an existing diagnosis of SLE and all initially developed a photodistributed annular eruption resembling cutaneous LE, which progressed to diffuse epidermal necrosis subacutely over the course of weeks to months.…”

Section: Discussion and Review Of The Literaturesupporting

confidence: 82%

Toxic Epidermal Necrolysis-Like Cutaneous Lupus in Pediatric Patients: A Case Series and Review

Brandling‐Bennett

et al. 2016

Pediatrics

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Bullous eruptions in patients with underlying systemic lupus erythematosus (LE) can mimic toxic-epidermal necrolysis (TEN), a rapidly progressive mucocutaneous reaction usually associated with medication use. Differentiating between classic drug-induced TEN and TEN-like cutaneous LE is important but difficult. We report a series of 3 patients with pediatric systemic LE who were admitted with severe worsening of skin disease resembling TEN. However, the initial photo-distribution of the eruption, subacute progression, limited mucosal involvement, mild systemic symptoms, supportive biopsy and laboratory results, and lack of culprit drugs was more suggestive of a TEN-like cutaneous LE. These patients recovered with various systemic immunosuppressive medications including methylprednisolone, intravenous immunoglobulin, and plasmapheresis. Our cases are rare and demonstrate key clinical and histologic features of TEN-like cutaneous LE in young patients and the importance of differentiating this entity from drug-induced TEN.

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Section: Discussion and Review Of The Literaturesupporting

confidence: 82%

Toxic Epidermal Necrolysis-Like Cutaneous Lupus in Pediatric Patients: A Case Series and Review

Brandling‐Bennett

et al. 2016

Pediatrics

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“…'nın 4 kadın hasta üzerinde tanımladığı, uzun süreli diskoid lupus eritematozus (DLE), pernio ve EM benzeri lezyonlarının beraber bulunduğu, laboratuvar testlerinden benekli paternde ANA pozitifliği, RF pozitifliği, anti-SJT günümüzde anti-RO ve pansitopenin eşlik ettiği bir sendromdur 1 . Tanımlandığı günden sonra sistemik ve kutanöz LE ile EM benzeri lezyonların birlikteliği de tanı kriterlerini tam olarak sağlamasa bile RS olarak anılmıştır [2][3][4] . Günümüzde RS'nin ayrı bir antite, LE ile EM'nin tesadüfi birlikteliği veya subakut kutanöz LE'nin bir alt tipi olduğuna dair farklı görüşler vardır.…”

Section: Discussionunclassified

“…Günümüzde RS'nin ayrı bir antite, LE ile EM'nin tesadüfi birlikteliği veya subakut kutanöz LE'nin bir alt tipi olduğuna dair farklı görüşler vardır. Tanımlandığından günümüze kadar literatürde RS olarak veya LE/EM-benzeri lezyonların birliktelik gösterdiği olgular ve LE ile ilişkili Steven-Johnson/Toksik epidermal nekroz olguları bulunmaktadır [2][3][4] . Bu olgularda deri lezyonları genel olarak 2 gruba ayrılmıştır.…”

Section: Discussionunclassified

“…Literatürde lupus eritematozusa eşlik eden StevenJohnson sendromu (SJS) ve toksik epidermal nekroliz (TEN) olguları da bildirilmiştir. Ancak sonraki yıllarda sendromun yeni tanı kriterleri belirlenmiş ve hastalığın lupusa eşlik eden eritema multiforme şeklinde gerçek bir sendrom mu yoksa kronik kutanöz lupus eritematozusun (KKLE) bir alt grubu mu olduğu tartışılmıştır 2 . Burada sistemik lupus eritematozusa eritema multiforme benzeri lezyonların eşlik ettiği Rowell sendromuyla benzer özelliklerde olan bir olgu tartışılmaktadır.…”

Section: Introductionunclassified

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A case of systemic lupus erythematosus exacerbated with erythema multiforme-like lesions

Özcan¹,

Arısoy²,

Aytekin³

et al. 2015

TURKDERM

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The association of lupus erythematosus (LE) and erythema multiforme (EM) in the presence of anti-nuclear antibodies (ANA), Sjogren syndrome antigen B (autoantigen La) (anti-SS-B/La) and rheumatoid factor (RF) positivity has been described as a new syndrome by Rowell et al. in 1962. In 2012, Torchia et al. suggested novel diagnostic criteria for Rowell syndrome (RS). However, a number of cases, which lack the full diagnostic criteria, have been reported as RS in the literature. The EM-like lesions seen in these cases have been proposed as a subtype of subacute cutaneous LE. This article presents the case of a 34-year-old female patient with histopathologically diagnosed discoid LE, EM-like lesions, and speckled-pattern ANA positivity. Localizations of malar rash, discoid rash and EM-like lesions were not typical in the patient, and there was no triggering factor. Due to the lack of fully novel diagnostic criteria for RS, we conclude that our case is an instance of SLE exacerbated with EM-like lesions. (Turkderm 2015; 49: 85-8)

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“…Finalmente, la localización de las lesiones en el síndrome de Rowell no es acral o mucosa como en el eritema multiforme clásico, por lo cual incluso han propuesto nuevos criterios (11).…”

Section: Medicinaunclassified

Necrólisis epidérmica tóxica y lupus eritematoso sistémico

Vélez¹,

Morales²,

Calle³

et al. 2018

CES Med.

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Comparte ResumenEl lupus eritematoso sistémico con manifestación tipo necrólisis epidérmi-ca tóxica es una entidad descrita recientemente y cada vez aparecen más reportes en la literatura. Se describe el caso de una paciente de 15 años con lupus eritematoso sistémico quien presentó una necrólisis epidérmica tóxica extensa, cuyas lesiones iniciales eran tipo eritema multiforme. Se discute el caso a la luz de la literatura actual sobre esta nueva entidad.Palabras clave: Necrolisis epidérmica tóxica; Eritema multiforme; Síndrome de Stevens Johnson; Lupus eritematoso sistémico; Lupus eritematoso cutáneo. AbstractToxic epidermal necrolysis (TEN)-like systemic lupus erythematosus is a recently described entity and more cases are being published in the literature today. We describe the case of a 15-year old patient with systemic lupus erythematosus who developed TEN that initially started with erythema multiforme (EM)-like lesiones. We discuss this case according to the published literature on this new entity.Keywords: Toxic epidermal necrolysis; Erythema multiforme; Stevens-Johnson syndrome; Systemic lupus erythematosus; Cutaneous lupus erythematosus Caso clínicoSe trataba de una niña de 15 años, residente en el departamento de Antioquia, con un cuadro clínico de tres meses de evolución que consistía en edema progresivo de cara y los miembros inferiores, junto a disnea de medianos esfuerzos y artralgias con artritis de ambas manos. Lo anterior asociado a un cuadro de 15 días de evolución de un rash morbiliforme en áreas fotoexpuestas, muy pruriginoso, que posteriormente se generalizó. La paciente consultó a un hospital de segundo nivel de atención, en donde le encontraron, adicionalmente, cifras elevadas de presión arterial.La menor fue hospitalizada por el servicio de medicina Interna y se le inició manejo con esteroides tópicos y antihistamínicos y le fueron solicitados exámenes paraclínicos, que reportaron: Hb 7,2, leucocitos de 5 800 (81 % de neutrófilos y 12 % linfocitos), anti-SM y anti-ADN positivos, anticuerpos antinucleares (ANA´S) reactivos 1:320 con patrón moteado, anti-Ro y anti-La negativos, velocidad de sedimentación globular 60, creatinina 2,05,

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Erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis associated with lupus erythematosus

Cited by 74 publications

References 10 publications

Toxic Epidermal Necrolysis-Like Cutaneous Lupus in Pediatric Patients: A Case Series and Review

Toxic Epidermal Necrolysis-Like Cutaneous Lupus in Pediatric Patients: A Case Series and Review

A case of systemic lupus erythematosus exacerbated with erythema multiforme-like lesions

Necrólisis epidérmica tóxica y lupus eritematoso sistémico

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