Progression of systemic lupus erythematosus associated with propofol administration: a case report

Abstract

Propofol is a sedative-hypnotic agent used as a general anaesthetic with a good safety profile. However, the potential risk for patients with systemic lupuserythematosus (SLE) receiving propofol remains unclear. We report the case of a patient who received an intravenous infusion of propofol for painless gastroscopy which exacerbated acute SLE despite no history of allergies. The adverse effect might be because propofol increased T helper cells and trigged the induction of B cell differentiation and plasmablast formation, which further promoted the secretion of auto-antibodies. This case shows that propofol can exacerbate SLE symptoms in some patients and highlights the importance of identifying potential immune-related factors before propofol administration, especially in patients with autoimmune diseases. It is important to be aware of and differentiate this uncommon and non-specific SLE manifestation from a myriad of disorders presenting with a primary digestive disorder in the outpatient clinic.

Propofol Induced Subacute Cutaneous Lupus Erythematosus: A Case Report

“…The pathophysiology of this condition will also require more investigation, but the increase in helper T-cell activity in both SLE patients and routine propofol exposure is a potential basis for exploration. 3,10 Steroids anecdotally improved this patient's clinical course during multiple cutaneous reactions, but the best management proved to be removal of propofol from her anesthetic plan. A heightened awareness of this uncommon reaction to propofol may produce more documented cases, facilitate quicker diagnoses with better management, and, ideally, help to identify other high-risk patients for whom it may be best to avoid propofol and prevent PISCLE.…”

“…2 Diligent review of the anesthetic records of this patient suggested propofol was likely associated with the patient’s postoperative rashes, a potential side effect of propofol that is infrequently described. 3 By removing propofol from the anesthetic plans of both her DIEP flap and reconstruction revision, and observing no perioperative cutaneous changes for the first time in her lengthy surgical history, the case was strengthened that propofol had very likely been responsible for her 7 previous eruptions.…”

“…There is little available literature describing similar dermatological reactions associated with propofol. Only a single case report from Yu et al 3 was found during the literature review. This case report—which included images of a rash appearing remarkably similar to those taken of our patient’s rashes—reinforced the conclusion that propofol could be the agent responsible for the recurrent postoperative rashes and gave the authors the confidence to proceed with the elective procedure.…”

“…The pathophysiology of this condition will also require more investigation, but the increase in helper T-cell activity in both SLE patients and routine propofol exposure is a potential basis for exploration. 3 , 10 …”

Consideraciones anestésicas en lupus eritematoso sistémico

“…Recientemente, se ha reportado un caso de exacerbación de LES gatillada por propofol. Se ha visto que éste puede aumentar la actividad de linfocitos T helper y la diferenciación de linfocitos B, aumentando la producción de anticuerpos, especialmente en pacientes con anticuerpos anti-DNA y antinucleares positivos, aunque faltan estudios para demostrar la significancia clínica de esto [17].…”