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Kaya Akca U, Sener S, Batu ED, Balik Z, Basaran O, Bilginer Y, Ozen S. Drug-induced lupus erythematosus in childhood: Case-based review. Lupus 2024; 33:737-748. [PMID: 38580326 DOI: 10.1177/09612033241245078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND Drug-induced lupus erythematosus (DILE) is the development of lupus-like syndrome following a drug exposure. DILE has been reported less frequently among children than adults. METHODS In this study, we present four children with DILE and similar published cases through a systematic literature review. RESULTS We report four children (three girls and one boy) who developed DILE associated with the use of topiramate, doxycycline, etanercept, and ethosuximide. Three of them were positive for anti-histone antibodies. In all patients, the drug was discontinued and symptoms resolved completely. The literature review revealed 48 articles describing 61 children with DILE. In the evaluation of 65 patients (our 4 patients and 61 patients from the literature), the most frequently reported drugs associated with DILE were ethosuximide (n = 13) and minocycline (n = 12). Fever (n = 33), arthralgia (n = 31), rash (n = 30), and arthritis (n = 29) were the most common clinical manifestations. Antinuclear antibody (ANA) was positive in 93.5% of patients and anti-histone antibodies were detected in 72.2% of the patients. As for treatment, the responsible drug was discontinued in all patients, and corticosteroids were initiated in 53.3%. Improvement was achieved in 92.0% of patients. CONCLUSION For children presenting with SLE features, proper drug history is crucial since DILE may be more frequent than anticipated. An association of the relevant drug with the symptoms, and resolution of symptoms on drug withdrawal provides evidence for the diagnosis of DILE.
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Affiliation(s)
- Ummusen Kaya Akca
- Department of Pediatrics, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Seher Sener
- Department of Pediatrics, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Zeynep Balik
- Department of Pediatrics, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ozge Basaran
- Department of Pediatrics, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
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2
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Fleshman T, Depew I, Snider W, Cook S. Subacute Cutaneous Lupus Erythematosus Secondary to Intravenous Immunoglobulin Infusions. Cureus 2024; 16:e63217. [PMID: 39070403 PMCID: PMC11281939 DOI: 10.7759/cureus.63217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Subacute cutaneous lupus erythematosus (SCLE) is a variant of cutaneous lupus erythematosus (CLE) characterized by distinct skin lesions. Clinical manifestations typically include annular or psoriasiform skin lesions, often localized in sun-exposed areas such as the chest and back. The pathogenesis of SCLE is largely unknown, and contributing factors include genetics, environmental exposures, and immunological dysregulation. SCLE may be idiopathic or drug-induced, with common triggers being calcium channel blockers, thiazide diuretics, and terbinafine. Intravenous immunoglobulin (IVIG) treatment, frequently used in various autoimmune conditions, has a rare association with SCLE. We report a case in which this condition arose during IVIG treatment for chronic inflammatory demyelinating polyneuropathy (CIDP). Knowledge of this rare effect is beneficial to all providers who prescribe IVIG, including neurology, rheumatology, and dermatology.
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Affiliation(s)
- Taylor Fleshman
- Dermatology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Ian Depew
- Dermatology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - William Snider
- Dermatology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Shane Cook
- Dermatology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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3
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Watjer RM, Eekhof JAH, Quint KD, Numans ME, Bonten TN. Severe drug eruption from oral terbinafine for mild onychomycosis-A case report from family practice and literature review: "Just an innocent little pill?". SAGE Open Med Case Rep 2024; 12:2050313X241235823. [PMID: 38444697 PMCID: PMC10913523 DOI: 10.1177/2050313x241235823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/11/2024] [Indexed: 03/07/2024] Open
Abstract
Onychomycosis is the most prevalent nail disease and is frequently encountered in clinical practice. Despite having multiple therapeutic options, of which systemic antifungals are the most effective, treatment is not always mandatory in all patients. Especially when considering systemic treatment, the risk of adverse reactions may outweigh the potential benefits of treatment. In this case report, we present a clinical case of a 49-year-old male patient with a blank past medical history who experienced a severe drug eruption from terbinafine prescribed for mild onychomycosis that required discontinuation of terbinafine, additional evaluation, and treatment of this adverse reaction.
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Affiliation(s)
- Roeland M Watjer
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Just AH Eekhof
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Department of Dermatology, Roosevelt Clinic, Leiden, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Tobias N Bonten
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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4
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Gartenberg A, Petrie A. Mixed connective tissue disease-myositis overlap syndrome presenting as an allergic disease process to the emergency department: A case report. Am J Emerg Med 2024; 76:271.e5-271.e8. [PMID: 38142167 DOI: 10.1016/j.ajem.2023.11.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND The "allergy epidemic" of the Western World, has led to an overwhelming number of emergency department presentations with allergic rhinitis, allergic conjunctivitis, atopic eczema, and asthma. Careful consideration should be given to screening for the typical signs and symptoms of Mixed connective tissue disease (MCTD) in patients presenting to the ED with what appears to be a simple allergic process. MCTD is a rare systemic rheumatic disease characterized by high levels of anti-U1RNP antibodies and various clinical signs and symptoms. The pathophysiology of MCTD is poorly understood. An association between allergen-mediated processes and MCTD has been reported in recent literature. Our case report involves a 40 year old African American female with initial outpatient presentation suggestive of atopic disease, with progressive worsening of symptoms while receiving allergen immunotherapy. The patient presented to the emergency department with bilateral leg cramping. The patient was found to have a CPK of 7000 unresponsive to fluids. The patient was evaluated by the Allergy and Rheumatology services. The patient was ultimately diagnosed with MCTD-Myositis Overlap Syndrome and started on steroids and IVIG with improvement in symptoms. While MCTD is not a diagnosis readily made in the ED, early identification and treatment of the disease is critical for prevention of long term complications.
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Affiliation(s)
- Ariella Gartenberg
- Department of Emergency Medicine at Jacobi Medical Center, Montefiore Medical Center, Bronx, NY, United States of America.
| | - Alexander Petrie
- Emergency Medicine at Jacobi Medical Center, North Central Bronx Hospital, Bronx, NY, United States of America
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5
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Heinly B, Allenzara A, Helm M, Foulke GT. Cutaneous Lupus Erythematosus: Review and Considerations for Older Populations. Drugs Aging 2024; 41:31-43. [PMID: 37991658 DOI: 10.1007/s40266-023-01079-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/23/2023]
Abstract
Though more common earlier in life, increasing attention is being focused on the development of cutaneous lupus erythematosus (CLE) in patients with advancing age. Studies show that CLE is more common in older populations than previously thought, and all CLE subtypes are possible in this group. Just like patients in the third or fourth decade of life, CLE may appear alongside or independent of systemic lupus erythematosus. Older populations manifesting CLE for the first time seem to have a lower risk of progression to systemic disease than younger peers, and are more commonly White. CLE must be carefully distinguished from other skin conditions that have a predilection for presentation in older populations, including rosacea, lichen planus, and other autoimmune conditions such as dermatomyositis or pemphigus/pemphigoid. It is thought that most CLE in older populations is drug-induced, with drug-induced subacute cutaneous lupus erythematosus being the most common subtype. Management of CLE in older patients focuses on eliminating unnecessary medications known to induce CLE, and otherwise treatment proceeds similarly to that in younger patients, with a few special considerations.
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Affiliation(s)
| | - Astia Allenzara
- Division of Rheumatology, Allergy and Immunology and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew Helm
- Department of Dermatology, Penn State College of Medicine, Hershey, PA, USA
| | - Galen T Foulke
- Department of Dermatology, Penn State College of Medicine, Hershey, PA, USA.
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
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6
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Nayak D, Behera B, Dalei SR, Kumar Mishra A, Marandi P. Changing Trends of Cutaneous Lupus Erythematosus (CLE) in a Tertiary Care Hospital in Northern Odisha, India. Cureus 2023; 15:e40466. [PMID: 37456488 PMCID: PMC10349591 DOI: 10.7759/cureus.40466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Cutaneous lupus erythematosus (CLE) is a chronic autoimmune inflammatory skin disorder. Several studies have been published regarding its prevalence, demographic details, clinical spectrum, and various associated factors. In our out patient department (OPD), we noticed an increase in the number of cases of CLE in our area in the last few years. Therefore, the current cross-sectional study was conducted to assess the trends of CLE among patients who reported to a tertiary care hospital. MATERIALS AND METHODS The current study is a record-based cross-sectional study of 81 patients of CLE, who attended the dermatology OPD of a tertiary care hospital. Data were collected from 2017 to 2022 and were divided into three different periods of time (2017-2018, 2019-2020, and 2021-2022). Demographic details, clinical examination findings, and laboratory investigation reports were also collected. RESULTS There was a rising trend in the cases of CLE. Females outnumbered males (2:1, 66.67%). The increase in cases from 2017-2018 to 2019-2020 was 157% and from 2019-2020 to 2021-2022 was 204%. In 2021-2022, 52% of cases of chronic CLE (CCLE) were males. Photosensitivity was the most common finding. The majority of patients were addicted to smoking. CONCLUSION The current study noticed an increasing trend in all types of CLE. So, this rising trend should be investigated for possible triggering factors like climatic changes, infections, and drug factors with a larger sample size.
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Affiliation(s)
- Debabrata Nayak
- Dermatology, Pandit Raghunath Murmu Medical College, Baripada, IND
| | - Binodini Behera
- Dermatology, Pandit Raghunath Murmu Medical College, Baripada, IND
| | | | - Amit Kumar Mishra
- Community and Family Medicine, All India Institute of Medical Sciences, Raipur, IND
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Xu K, Zhang M, Yang S, Yu G, Zheng P, Qin X, Feng J. Subacute cutaneous lupus erythematosus as a rare complication of disease-modifying therapy administration in multiple sclerosis: case report. BMC Neurol 2023; 23:168. [PMID: 37101279 PMCID: PMC10131458 DOI: 10.1186/s12883-023-03146-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/27/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Teriflunomide, the active metabolite of leflunomide, is a disease-modifying therapy drug used for the treatment of multiple sclerosis (MS), yet the complications associated with this drug remain not fully understood. Here we present the rare case of a 28-year-old female MS patient who developed subacute cutaneous lupus erythematosus (SCLE) following teriflunomide treatment. Though SCLE has been reported to be associated with leflunomide, the current report represents the first documented evidence demonstrating SCLE as a potential teriflunomide treatment-related complication. Additionally, a literature review on the leflunomide-induced SCLE was conducted to emphasize the association of SCLE with teriflunomide, specifically amongst the female demographic with a preexisting autoimmune diathesis. CASE PRESENTATION A 28-year-old female first presented with MS symptoms in the left upper limb along with blurred vision in the left eye. Medical and family histories were unremarkable. The patient exhibited positive serum biomarkers including ANA, Ro/SSA, La/SSB, and Ro-52 antibodies. Relapsing-remitting MS was diagnosed according to the 2017 McDonald's diagnostic criteria, and remission was achieved upon intravenous administration of methylprednisolone followed by teriflunomide sequential therapy. Three months post-teriflunomide treatment, the patient developed multiple facial cutaneous lesions. SCLE was subsequently diagnosed and was attributed to treatment-related complication. Interventions include oral administration of hydroxychloroquine and tofacitinib citrate effectively resolved cutaneous lesions. Discontinuation of hydroxychloroquine and tofacitinib citrate treatment led to recurring SCLE symptoms under continuous teriflunomide treatment. Full remission of facial annular plaques was achieved after re-treatment with hydroxychloroquine and tofacitinib citrate. The patient's clinical condition remained stable in long-term outpatient follow-ups. CONCLUSIONS As teriflunomide has become a standard disease-modifying therapy for MS, the current case report highlights the importance of monitoring treatment-related complications, specifically in relation to SCLE symptoms.
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Affiliation(s)
- Ke Xu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- National Health Commission Key Laboratory of Diagnosis and Treatment On Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mengjie Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shilin Yang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Gang Yu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Zheng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- National Health Commission Key Laboratory of Diagnosis and Treatment On Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyue Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Jinzhou Feng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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8
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Hoque MR, Lu L, Daftarian N, Esdaile JM, Xie H, Aviña-Zubieta JA. Risk of Arrhythmia Among New Users of Hydroxychloroquine in Rheumatoid Arthritis and Systemic Lupus Erythematosus: A Population-Based Study. Arthritis Rheumatol 2023; 75:475-484. [PMID: 36054570 DOI: 10.1002/art.42337] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We assessed the association between hydroxychloroquine (HCQ) initiation and risk of arrhythmia among patients with incident rheumatoid arthritis (RA) or with incident systemic lupus erythematosus (SLE). METHODS All patients with incident RA or SLE and no arrhythmic events, not receiving antiarrhythmic medications, and not receiving HCQ prior to the index date of disease in British Columbia, Canada, between January 1996 and December 2014 were identified from administrative databases. We identified patients who were dispensed HCQ prescriptions (HCQ initiators) or were not dispensed HCQ prescriptions (HCQ noninitiators) during each study year; groups were matched 1:1 by propensity scores using baseline confounders on demographics, comorbidities, medications, and health care utilization. Outcomes were any new arrhythmias, atrial fibrillation, abnormal electrocardiograms, including long QT syndrome and conduction disorder, and other unspecified arrhythmias during follow-up. We used cause-specific Cox proportional hazards models with death as a competing event to assess the association between HCQ initiation and the outcomes. RESULTS We identified 11,518 propensity score-matched patients with RA or SLE in each group. Over the mean follow-up of 8 years, there were 1,610 and 1,646 incident arrhythmias in the HCQ initiator group and the noninitiator group, respectively, with crude incidence rates of arrhythmia of 17.5 and 18.1 in 1,000 persons per year, respectively. The adjusted cause-specific hazard ratio (cHR) for patients who received HCQ was 0.96 (95% confidence interval [95% CI] 0.89-1.03) compared with HCQ noninitiators, and the cHRs for patients who took HCQ and had arrhythmia subtypes of atrial fibrillation, abnormal electrocardiograms, and other unspecified arrhythmias were 0.93 (95% CI 0.83-1.04), 0.98 (95% CI 0.87-1.11), and 0.95 (95% CI 0.84-1.07), respectively. CONCLUSION Risk of any type of arrhythmia was not increased among new users of HCQ.
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Affiliation(s)
- M Rashedul Hoque
- Arthritis Research Canada, Vancouver, Canada, and Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Leo Lu
- Arthritis Research Canada, Vancouver, Canada
| | | | - John M Esdaile
- Arthritis Research Canada, Vancouver, Canada, and Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, Canada, and Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, Vancouver, Canada, and Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, Canada
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9
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Bieber K, Hundt JE, Yu X, Ehlers M, Petersen F, Karsten CM, Köhl J, Kridin K, Kalies K, Kasprick A, Goletz S, Humrich JY, Manz RA, Künstner A, Hammers CM, Akbarzadeh R, Busch H, Sadik CD, Lange T, Grasshoff H, Hackel AM, Erdmann J, König I, Raasch W, Becker M, Kerstein-Stähle A, Lamprecht P, Riemekasten G, Schmidt E, Ludwig RJ. Autoimmune pre-disease. Autoimmun Rev 2023; 22:103236. [PMID: 36436750 DOI: 10.1016/j.autrev.2022.103236] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Abstract
Approximately 5% of the world-wide population is affected by autoimmune diseases. Overall, autoimmune diseases are still difficult to treat, impose a high burden on patients, and have a significant economic impact. Like other complex diseases, e.g., cancer, autoimmune diseases develop over several years. Decisive steps in the development of autoimmune diseases are (i) the development of autoantigen-specific lymphocytes and (often) autoantibodies and (ii) potentially clinical disease manifestation at a later stage. However, not all healthy individuals with autoantibodies develop disease manifestations. Identifying autoantibody-positive healthy individuals and monitoring and inhibiting their switch to inflammatory autoimmune disease conditions are currently in their infancy. The switch from harmless to inflammatory autoantigen-specific T and B-cell and autoantibody responses seems to be the hallmark for the decisive factor in inflammatory autoimmune disease conditions. Accordingly, biomarkers allowing us to predict this progression would have a significant impact. Several factors, such as genetics and the environment, especially diet, smoking, exposure to pollutants, infections, stress, and shift work, might influence the progression from harmless to inflammatory autoimmune conditions. To inspire research directed at defining and ultimately targeting autoimmune predisease, here, we review published evidence underlying the progression from health to autoimmune predisease and ultimately to clinically manifest inflammatory autoimmune disease, addressing the following 3 questions: (i) what is the current status, (ii) what is missing, (iii) and what are the future perspectives for defining and modulating autoimmune predisease.
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Affiliation(s)
- Katja Bieber
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany
| | - Jennifer E Hundt
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany
| | - Xinhua Yu
- Priority Area Chronic Lung Diseases, Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - Marc Ehlers
- Institute of Nutritional Medicine, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Frank Petersen
- Priority Area Chronic Lung Diseases, Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - Christian M Karsten
- Institute for Systemic Inflammation Research, University of Lübeck, 23562 Lübeck, Germany
| | - Jörg Köhl
- Institute for Systemic Inflammation Research, University of Lübeck, 23562 Lübeck, Germany; Division of Immunobiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; Unit of Dermatology and Skin Research Laboratory, Baruch Padeh Medical Center, Poriya, Israel
| | - Kathrin Kalies
- Institute of Anatomy, University of Lübeck, Lübeck, Germany
| | - Anika Kasprick
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany
| | - Stephanie Goletz
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany
| | - Jens Y Humrich
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Rudolf A Manz
- Institute for Systemic Inflammation Research, University of Lübeck, 23562 Lübeck, Germany
| | - Axel Künstner
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany
| | - Christoph M Hammers
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany
| | - Reza Akbarzadeh
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Hauke Busch
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany
| | | | - Tanja Lange
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Hanna Grasshoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Alexander M Hackel
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Jeanette Erdmann
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Inke König
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Walter Raasch
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Lübeck, Germany
| | - Mareike Becker
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Anja Kerstein-Stähle
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany; Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany.
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Chander Y. Prevalence of Antineutrophil Cytoplasmic Antibodies and Antinuclear Antibodies in Patients with Pulmonary Tuberculosis: A Tertiary Care Center Experience from North India. JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2022. [DOI: 10.5005/japi-11001-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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11
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Goldman N, Han J, LaChance A. Diagnosis and Management of Cutaneous Manifestations of Autoimmune Connective Tissue Diseases. Clin Cosmet Investig Dermatol 2022; 15:2285-2312. [PMID: 36320926 PMCID: PMC9618245 DOI: 10.2147/ccid.s360801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/19/2022] [Indexed: 11/20/2022]
Abstract
The cutaneous features of autoimmune connective tissue disease pose a unique challenge to patients and clinicians managing these conditions. In this review, we outline the key elements of diagnosis and treatment of cutaneous lupus erythematosus, dermatomyositis, systemic sclerosis, and morphea. This article also aims to present an update on gold standard as well as new and emerging therapies for these conditions. Overall, dermatologists can play a key role in diagnosing and treating autoimmune connective tissue diseases and this review intends to provide an up-to-date toolkit to guide clinical dermatologists in this endeavor.
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Affiliation(s)
- Nathaniel Goldman
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- New York Medical College, School of Medicine, Valhalla, NY, USA
| | - Joseph Han
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Avery LaChance
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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12
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Guo H, Zhang P, Zhang R, Hua Y, Zhang P, Cui X, Huang X, Li X. Modeling and insights into the structural characteristics of drug-induced autoimmune diseases. Front Immunol 2022; 13:1015409. [PMID: 36353637 PMCID: PMC9637949 DOI: 10.3389/fimmu.2022.1015409] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/11/2022] [Indexed: 09/12/2023] Open
Abstract
The incidence and complexity of drug-induced autoimmune diseases (DIAD) have been on the rise in recent years, which may lead to serious or fatal consequences. Besides, many environmental and industrial chemicals can also cause DIAD. However, there are few effective approaches to estimate the DIAD potential of drugs and other chemicals currently, and the structural characteristics and mechanism of action of DIAD compounds have not been clarified. In this study, we developed the in silico models for chemical DIAD prediction and investigated the structural characteristics of DIAD chemicals based on the reliable drug data on human autoimmune diseases. We collected 148 medications which were reported can cause DIAD clinically and 450 medications that clearly do not cause DIAD. Several different machine learning algorithms and molecular fingerprints were combined to develop the in silico models. The best performed model provided the good overall accuracy on validation set with 76.26%. The model was made freely available on the website http://diad.sapredictor.cn/. To further investigate the differences in structural characteristics between DIAD chemicals and non-DIAD chemicals, several key physicochemical properties were analyzed. The results showed that AlogP, molecular polar surface area (MPSA), and the number of hydrogen bond donors (nHDon) were significantly different between the DIAD and non-DIAD structures. They may be related to the DIAD toxicity of chemicals. In addition, 14 structural alerts (SA) for DIAD toxicity were detected from predefined substructures. The SAs may be helpful to explain the mechanism of action of drug induced autoimmune disease, and can used to identify the chemicals with potential DIAD toxicity. The structural alerts have been integrated in a structural alert-based web server SApredictor (http://www.sapredictor.cn). We hope the results could provide useful information for the recognition of DIAD chemicals and the insights of structural characteristics for chemical DIAD toxicity.
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Affiliation(s)
- Huizhu Guo
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China
| | - Peitao Zhang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China
| | - Ruiqiu Zhang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China
| | - Yuqing Hua
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China
| | - Pei Zhang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China
| | - Xueyan Cui
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China
| | - Xin Huang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China
| | - Xiao Li
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China
- Department of Clinical Pharmacy, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
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13
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Autoantibody profile in sarcoidosis, analysis from the GRADS sarcoidosis cohort. PLoS One 2022; 17:e0274381. [PMID: 36264970 PMCID: PMC9584415 DOI: 10.1371/journal.pone.0274381] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sarcoidosis, a multi-systemic granulomatous disease, is a predominantly T-cell disease but evidence for a role for humoral immunity in disease pathogenesis is growing. Utilizing samples from the Genomic Research in Alpha-1 anti-trypsin Deficiency and Sarcoidosis (GRADS) study, we examined the prevalence of autoantibodies in sarcoidosis patients with pulmonary-only and extra-pulmonary organ involvement compared to normal controls. STUDY DESIGN AND METHODS We analyzed serum samples from sarcoidosis patients who participated in the GRADS study utilizing an autoantigen microarray platform for both IgM and IgG antibodies. The cohort included sarcoidosis patients with pulmonary-only disease (POS, n = 106), sarcoidosis patients with extra-pulmonary disease (EPS, n = 120) and a normal control cohort (NC, n = 101). Organ involvement was assessed following a standardized format across all GRADS participating centers. RESULTS Sarcoidosis patients overall had increased levels of IgM and IgG autoantibodies compared to normal controls. In addition, several autoantibodies were elevated in the POS and EPS cohorts compared to the NC cohort. Differences in autoantibody levels were also noted between the POS and the EPS cohorts. When comparing organ involvement with sarcoidosis, bone, spleen and ear, nose and throat involvement had higher IgM expression than other organs. CONCLUSION Sarcoidosis patients have elevated IgM and IgG autoantibody levels compared to normal controls. In addition, individuals with pulmonary as well as additional organ involvement had higher IgM expression. Further research is needed focusing on specific organ-autoantibody pairs and role of autoantibodies in disease pathogenesis.
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New-onset systemic lupus erythematosus following BNT162b2 mRNA COVID-19 vaccine: a case series and literature review. Rheumatol Int 2022; 42:2261-2266. [PMID: 36098769 PMCID: PMC9468534 DOI: 10.1007/s00296-022-05203-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/29/2022] [Indexed: 11/24/2022]
Abstract
Emerging data evaluated the possible link between the Coronavirus 19 (COVID-19) vaccine and acute flares of rheumatic autoimmune diseases. However, the association between the COVID-19 vaccine and the development of de-novo rheumatic autoimmune diseases remained unclear. We report the first case series of three male patients who developed new-onset systemic lupus erythematosus following receiving Pfizer BNT162b2 mRNA vaccination. The clinical characteristics share some similarities with drug-induced lupus. More patients with SLE following COVID-19 may be diagnosed in the future. Additional studies will provide more significant insights into the possible immunogenic influence of the COVID-19 vaccine.
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15
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Liposomes Bearing Non-Bilayer Phospholipid Arrangements Induce Specific IgG Anti-Lipid Antibodies by Activating NK1.1+, CD4+ T Cells in Mice. MEMBRANES 2022; 12:membranes12070643. [PMID: 35877846 PMCID: PMC9319584 DOI: 10.3390/membranes12070643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 12/04/2022]
Abstract
Liposomes are artificial models of cellular membranes that are used as delivery systems for genes, drugs and protein antigens. We have previously used them to study the antigenic properties of their phospholipids. Here, we used them to induce the production of IgG anti-non-bilayer phospholipid arrangements (NPAs) antibodies in mice; these antibodies cause cell lysis and trigger a lupus-like disease in mice. We studied the mechanisms that lead to the production of these antibodies, and provide evidence that NK1.1+, CD4+ T cells respond to NPA-bearing liposomes and deliver the help required for specific B cell activation and antibody class-switching to IgG. We found increased numbers of IL-4-producing NK1.1+, CD4+ T cells in the secondary lymphoid organs of mice administered with NPAs, and these cells also expressed CD40L, which is required for B cell activation. Additionally, we isolated and purified NK1.1+, CD4+ T cells from spleens and determined that they over-expressed 40 genes, which are key players in inflammatory processes and B cell stimulation and have TRAF6 and UNC39B1 as key nodes in their network. These results show that liposomes are membrane models that can be used to analyze the immunogenicity of lipids.
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Miyagawa F. Pathogenesis of Paradoxical Reactions Associated with Targeted Biologic Agents for Inflammatory Skin Diseases. Biomedicines 2022; 10:biomedicines10071485. [PMID: 35884790 PMCID: PMC9312477 DOI: 10.3390/biomedicines10071485] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
Targeted biologic agents have dramatically changed the therapeutic landscape for immune-mediated inflammatory diseases, particularly in rheumatology and dermatology. Their introduction has resulted in a paradigm shift, i.e., they produce significant clinical improvements in most patients with such diseases. Nevertheless, a variety of adverse reactions associated with these agents have been observed, including so-called paradoxical reactions (PRs), which are a new class of adverse events. PRs involve the de novo development or worsening of immune-mediated inflammatory disease during treatment with a targeted biologic agent that is commonly used to treat the idiopathic counterpart of the drug-induced reaction. In addition, the efficacy of biologic agents targeting individual cytokines and the existence of PRs to them have provided proof that cytokines are key drivers of various immune-mediated inflammatory diseases and helped researchers elucidate the molecular pathways underlying the pathophysiology of these diseases. Here, a comprehensive review of the targeted biologic agents used to treat immune-mediated inflammatory diseases, particularly psoriasis and atopic dermatitis, is provided, with a specific focus on biologic agents that inhibit cytokine signaling involving tumor necrosis factor-α, interleukin (IL)-12/23 (p40), IL-17A (and the IL-17 receptor [R]), IL-23 (p19), and the IL-4Rα, and their associated PRs. The characteristic clinical manifestations and potential immunological mechanisms of the PRs induced by these biologic agents are also reviewed.
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Affiliation(s)
- Fumi Miyagawa
- Department of Dermatology, Nara Medical University School of Medicine, Nara 634-8522, Japan
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17
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Abstract
Anti-histone antibodies (AHAs) make their appearance in a number of systemic autoimmune diseases including systemic lupus erythematosus (SLE) and drug-induced lupus erythematosus (DILE). Although being known for over 50 years, they are poorly studied and understood. There is emerging evidence for their use in predicting clinical features of SLE, diversifying their clinical use. AHAs, however, are probably less prevalent in DILE than once thought owing to a move away from older DILE drugs to modern biological agents which do not appear to elicit AHAs. This review examines the historical studies that have defined AHAs and looks at some of the recent work with these autoantibodies.
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Affiliation(s)
- Adrian Y S Lee
- Department of Immunology, Westmead Hospital, Westmead, Australia.,ICPMR, NSW Health Pathology, Westmead, Australia.,Westmead Clinical School, University of Sydney, Westmead, Australia
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18
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Papadopoulou E, Saroglou M, Ismailos G, Fletsios D, Tsavlis D, Tryfon S. Pearls for the diagnosis and possible pathophysiological mechanisms of valproic acid-induced lupus erythematosus: A literature review. Lupus 2022; 31:650-658. [PMID: 35324365 DOI: 10.1177/09612033221088445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Drug-induced lupus erythematosus (DILE) accounts for 10-15% of systemic lupus erythematosus (SLE) cases, with more than 100 pharmaceutical agents implicated in its development. Depending on the offending drug, clinical and serological manifestations present great variability and, thus, DILE may be overlooked in clinical practice. Valproic acid (VPA) - induced lupus erythematosus has not been analytically reported in the literature, rendering the recognition of such cases even more difficult.Objective: The aim of this study was to analyze VPA - induced lupus features and to discuss possible pathophysiological mechanisms.Materials and Methods: This literature review was conducted in PubMed and Embase databases in June 2021, in search of DILE cases induced by VPA. We found 164 manuscripts, out of which 140 articles regarding other adverse effects or drugs were discarded. Finally, 15 cases fulfilled the eligibility criteria to be included in this review.Results: Although SLE is more common in females, VPA-induced lupus presented a male predilection. Patients developed DILE within the first three months of treatment with VPA at a percentage of 50%, whereas four patients from one to five years after VPA initiation. DILE frequently presented with mild symptoms. In most patients, serositis manifested with polyarthritis, pleural effusion or pericarditis. Notably, one patient presented with Rowell's syndrome, a rare subtype of lupus erythematosus with erythema multiforme and speckled pattern of antinuclear antibodies (ANAs). Central nervous system, renal and skin involvement was scarcely observed. Cytopenia was noted in 7 patients. Immunological findings included positive ANAs in the vast majority of the patients (86.7%), positive anti-histone antibodies in five, positive anti-dsDNA antibodies in three and hypocomplementemia in two patients. Despite the prompt resolution of clinical symptoms after VPA discontinuation, serological abnormalities persisted up to 18 months. Apart from the discontinuation of VPA administration for the resolution of DILE, treatment included corticosteroids in 8 cases.Conclusion: Valproic acid has been implicated in several cases of DILE. Clinicians should be aware of this entity and recognize it promptly to ensure a favorable outcome. Possible pathophysiologic associations may be extrapolated, but a clearer understanding of this syndrome is to be gained by further studies.
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Affiliation(s)
- Efthymia Papadopoulou
- Pulmonology Department NHS, 551666General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, Greece
| | - Maria Saroglou
- Pulmonology Department NHS, 551666General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, Greece
| | - Georgios Ismailos
- Experimental Research Center ELPEN, ELPEN Pharmaceuticals, Pikermi, Greece
| | - Demosthenes Fletsios
- Pulmonology Department NHS, 551666General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, Greece
| | - Drosos Tsavlis
- Department of Medicine, Laboratory of Experimental Physiology, 37783Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Tryfon
- Pulmonology Department NHS, 551666General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, Greece
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19
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Kharayat V, Sinha P, Madakshira M, Prashar M. Discoid lupus erythematosus like lesions after imatinib therapy: A rare case report. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2022. [DOI: 10.4103/ijdd.ijdd_31_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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20
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Sinha A, Hegde A, Kinra P, Neema S, Singh AR. Oxcarbazepine-induced systemic lupus erythematosus: A rare and serious adverse drug reaction to a common anticonvulsant. Indian J Pharmacol 2021; 53:412-414. [PMID: 34854412 PMCID: PMC8641743 DOI: 10.4103/ijp.ijp_445_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Anwita Sinha
- Department of Dermatology, Military Hospital Kirkee, Pune, Maharashtra, India
| | - Arun Hegde
- Department of Rheumatology, Command Hospital Pune, Pune, Maharashtra, India
| | - Prateek Kinra
- Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Shekhar Neema
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Anchit Raj Singh
- Department of Medicine, Armed Forces Medical College, Pune, Maharashtra, India
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21
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Quddusi FI, Youssef MJ, Davis DMR. Dermatologic Manifestations of Systemic Diseases in Childhood. Pediatr Rev 2021; 42:655-671. [PMID: 34850179 DOI: 10.1542/pir.2020-000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Molly J Youssef
- Department of Pediatric and Adolescent Medicine.,Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Dawn Marie R Davis
- Department of Pediatric and Adolescent Medicine.,Department of Dermatology, Mayo Clinic, Rochester, MN
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22
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Kosugi S, Yoshida T, Yoshimoto N, Itoh H, Oya M. A Case of New-Onset Systemic Lupus Erythematosus With Serositis in a Maintenance Hemodialysis Patient. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:11795476211056172. [PMID: 34720604 PMCID: PMC8554544 DOI: 10.1177/11795476211056172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022]
Abstract
A 61-year-old woman with a 4-year history of maintenance hemodialysis due to end-stage renal disease of unknown cause was admitted because of a recurrent fever and abdominal pain lasting for 3 months. She had rheumatoid arthritis as a complication and had taken sulfasalazine for over 4 years. Laboratory data revealed thrombocytopenia, hypocomplementemia, a high C-reactive protein level, and positivity for antinuclear antibody and anti-double strand DNA antibody. Gallium scintigraphy showed pericarditis, pleuritis, and peritonitis. Nonscarring alopecia was also noted. She was diagnosed as having systemic lupus erythematosus (SLE). Drug-induced lupus elicited by sulfasalazine was ruled out because the symptoms did not improve even after the discontinuation of the drug upon admission. Oral prednisolone treatment markedly improved her symptoms and laboratory data. However, she later died of sepsis arising from proctitis on day 71 of admission. This report underscores the necessity of considering new-onset SLE in patients with unexplained fever and serositis, including pleuritis, peritonitis, or pericarditis, even if they are receiving maintenance dialysis.
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Affiliation(s)
- Shotaro Kosugi
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tadashi Yoshida
- Apheresis and Dialysis Center, Keio University School of Medicine, Tokyo, Japan
| | - Norifumi Yoshimoto
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Itoh
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Apheresis and Dialysis Center, Keio University School of Medicine, Tokyo, Japan.,Department of Urology, Keio University School of Medicine, Tokyo, Japan
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23
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Mobini M, Ghasemian R, Vahedi Larijani L, Mataji M, Maleki I. Immunologic markers, vasculitis-associated autoantibodies, and complement levels in patients with COVID-19. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2021; 26:103. [PMID: 34899941 PMCID: PMC8607177 DOI: 10.4103/jrms.jrms_923_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/15/2020] [Accepted: 02/24/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The cause of coronavirus disease 2019 (COVID-19) is a virus which can lead to severe acute respiratory syndrome-CoV-2 (SARS-COV-2). There are evidences of involvement of immune system in pathogenesis of this disease. We investigated the presence of various vasculitis-associated autoantibodies and complement levels in patients with COVID-19. MATERIALS AND METHODS Patients with severe or critical type of COVID-19 were evaluated for symptoms, signs, and laboratory tests of vasculitis syndromes including rheumatoid factor (RF), antinuclear antibody (ANA), anti-double-stranded DNA, c and p anti-neutrophilic cytoplasmic antibody (c ANCA and P ANCA), and complement levels. RESULTS The study was performed in forty patients with severe or critical illness. The mean age of the participants was 48.5 ± 9.8 years. All patients had pulmonary involvement in lung computed tomography scans. Vasculitis laboratory test results included RF in two patients, ANA in three patients, and ANCA in one patient. Seventeen (42.5%) patients had hypocomplementemia in one or more complement tests. Four patients expired, of whom three had a decrease in complement level. CONCLUSION Decrease in complement levels may predict a critical state of COVID-19 disease. Therefore, measuring its levels may be of great benefit in making earlier decisions to initiate disease-suppressing treatments including corticosteroids.
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Affiliation(s)
- Maryam Mobini
- Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roya Ghasemian
- Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Laleh Vahedi Larijani
- Immunogenetic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maede Mataji
- Department of Internal Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iradj Maleki
- Gut and Liver Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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24
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Saeed HM, Mohammad Amr E, Rezk Lotfy Rezk A, Abd Elmoneim W. Prevalence of oral manifestations in patients with lupus erythematosus in a sample of the Egyptian population: a hospital based cross-sectional study. F1000Res 2021; 10:969. [PMID: 35707453 PMCID: PMC9178282 DOI: 10.12688/f1000research.55332.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Several systemic diseases manifest themselves in the oral cavity. Dentists who are unaware of these lesions will possibly miss them. This cross-sectional study aimed to assess the prevalence of oral manifestations in patients with LE in a sample of the Egyptian population. Methods: The present cross-sectional study was performed on 189 patients attending the Internal Medicine Department, Rheumatology Clinic in EL Qasr El Ainy Hospital, Cairo University. Every patient was examined clinically after completing a questionnaire. Patients' medical records were evaluated. The oral manifestations were assessed according to the WHO guide to physical examination of the oral cavity and classified according to their morphologic aspects and localization. Results: Out of 189 patients, there were 182 females (96.3%) and seven males (3.7%). The prevalence of oral lesions in SLE patients was 55.6%. The most affected site was the tongue 25.7%. The most common clinical aspect was patches, 53%. About 77.1% of the lesions were asymptomatic. Conclusions: The present study emphasizes the importance of early diagnosis of oral lesions to recognize patients with SLE as the WHO considers oral manifestations of SLE a widespread state. Also, the implementation of oral hygiene measures to improve patients' nutritional state and health-related quality of life is recommended.
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Affiliation(s)
- Hager Moustafa Saeed
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Eman Mohammad Amr
- Department of Oral Medicine and Periodontology, Cairo University, Cairo, 11562, Egypt
| | | | - Wesam Abd Elmoneim
- Department of Oral Medicine and Periodontology, Cairo University, Cairo, 11562, Egypt
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25
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Saeed HM, Mohammad Amr E, Rezk Lotfy Rezk A, Abd Elmoneim W. Prevalence of oral manifestations in patients with lupus erythematosus in a sample of the Egyptian population: a hospital based cross-sectional study. F1000Res 2021; 10:969. [PMID: 35707453 PMCID: PMC9178282 DOI: 10.12688/f1000research.55332.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/06/2023] Open
Abstract
Background: Several systemic diseases manifest themselves in the oral cavity. Oral manifestations of lupus erythematosus (LE) are associated with a significantly increased risk of cancer. Dentists who are unaware of these lesions will possibly miss them. This cross-sectional study aimed to assess the prevalence of oral manifestations in patients with LE in a sample of the Egyptian population. Methods: A descriptive study was performed on 189 patients attending the Internal Medicine Department, Rheumatology Clinic in EL Qasr EL Ainy Hospital, Cairo University. Every patient was examined clinically after completing a questionnaire. Moreover, patients' medical records were also evaluated. The oral manifestations were recorded according to the WHO guide to physical examination of the oral cavity and classified according to their morphologic aspects and localization. Results: Out of 189 patients, there were 182 females (96.3%) and seven males (3.7%). The prevalence of oral lesions in LE patients was 55.6%. The most affected site was the tongue 25.7%. The most common clinical aspect was patches, 53%. About 77.1% of the lesions were asymptomatic. Conclusions: The present study emphasizes the importance of early diagnosis of oral lesions to recognize patients with LE as the WHO considers oral manifestations of LE a widespread state. Also, implementation of oral hygiene measures and treatment to improve patients' nutritional state and health-related quality of life are recommended.
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Affiliation(s)
- Hager Moustafa Saeed
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Eman Mohammad Amr
- Department of Oral Medicine and Periodontology, Cairo University, Cairo, 11562, Egypt
| | | | - Wesam Abd Elmoneim
- Department of Oral Medicine and Periodontology, Cairo University, Cairo, 11562, Egypt
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26
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Saeed HM, Mohammad Amr E, Rezk Lotfy Rezk A, Abd Elmoneim W. Prevalence of oral manifestations in patients with lupus erythematosus in a sample of the Egyptian population: a hospital based cross-sectional study. F1000Res 2021; 10:969. [PMID: 35707453 PMCID: PMC9178282 DOI: 10.12688/f1000research.55332.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/06/2023] Open
Abstract
Background: Several systemic diseases manifest themselves in the oral cavity. Dentists who are unaware of these lesions will possibly miss them. This cross-sectional study aimed to assess the prevalence of oral manifestations in patients with LE in a sample of the Egyptian population. Methods: A descriptive study was performed on 189 patients attending the Internal Medicine Department, Rheumatology Clinic in EL Qasr EL Ainy Hospital, Cairo University. Every patient was examined clinically after completing a questionnaire. Moreover, patients' medical records were also evaluated. The oral manifestations were recorded according to the WHO guide to physical examination of the oral cavity and classified according to their morphologic aspects and localization. Results: Out of 189 patients, there were 182 females (96.3%) and seven males (3.7%). The prevalence of oral lesions in SLE patients was 55.6%. The most affected site was the tongue 25.7%. The most common clinical aspect was patches, 53%. About 77.1% of the lesions were asymptomatic. Conclusions: The present study emphasizes the importance of early diagnosis of oral lesions to recognize patients with SLE as the WHO considers oral manifestations of SLE a widespread state. Also, implementation of oral hygiene measures and treatment to improve patients' nutritional state and health-related quality of life are recommended.
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Affiliation(s)
- Hager Moustafa Saeed
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Eman Mohammad Amr
- Department of Oral Medicine and Periodontology, Cairo University, Cairo, 11562, Egypt
| | | | - Wesam Abd Elmoneim
- Department of Oral Medicine and Periodontology, Cairo University, Cairo, 11562, Egypt
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Worm M, Zidane M, Eisert L, Fischer-Betz R, Foeldvari I, Günther C, Iking-Konert C, Kreuter A, Müller-Ladner U, Nast A, Ochsendorf F, Schneider M, Sticherling M, Tenbrock K, Wenzel J, Kuhn A. S2k-Leitlinie zur Diagnostik und Therapie des kutanen Lupus erythematodes - Teil 2: Therapie, Risikofaktoren und spezielle Fragestellungen. J Dtsch Dermatol Ges 2021; 19:1371-1395. [PMID: 34541800 DOI: 10.1111/ddg.14491_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Margitta Worm
- Allergologie und Immunologie, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Miriam Zidane
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Lisa Eisert
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | - Rebecca Fischer-Betz
- Poliklinik und Funktionsbereich für Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | - Ivan Foeldvari
- Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg
| | - Claudia Günther
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden
| | - Christof Iking-Konert
- Zentrum für Innere Medizin der III. Medizinischen Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Alexander Kreuter
- Dermatologie, Venerologie und Allergologie, Helios St. Elisabeth Klinik Oberhausen, Oberhausen
| | - Ulf Müller-Ladner
- Abteilung für Rheumatologie und Klinische Immunologie, Kerckhoff-Klinik GmbH, Bad Nauheim
| | - Alexander Nast
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Falk Ochsendorf
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt am Main
| | - Matthias Schneider
- Poliklinik und Funktionsbereich für Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | | | - Klaus Tenbrock
- Klinik für Kinder- und Jugendmedizin, Uniklinik RWTH Aachen, Aachen
| | - Jörg Wenzel
- Dermatologische Klinik, Universitätsklinikum Bonn, Bonn
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Worm M, Zidane M, Eisert L, Fischer-Betz R, Foeldvari I, Günther C, Iking-Konert C, Kreuter A, Müller-Ladner U, Nast A, Ochsendorf F, Schneider M, Sticherling M, Tenbrock K, Wenzel J, Kuhn A. S2k guideline: Diagnosis and management of cutaneous lupus erythematosus - Part 2: Therapy, risk factors and other special topics. J Dtsch Dermatol Ges 2021; 19:1371-1395. [PMID: 34338428 DOI: 10.1111/ddg.14491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Margitta Worm
- Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
| | - Miriam Zidane
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
| | - Lisa Eisert
- Department of Dermatology and Venereology, Vivantes Klinikum Neukölln, Berlin
| | | | - Ivan Foeldvari
- Hamburg Center for Pediatric and Adolescent Rheumatology, Hamburg
| | - Claudia Günther
- Department and Clinic of Dermatology, University Hospital Carl Gustav Carus, Dresden
| | - Christof Iking-Konert
- Center for Internal Medicine at the IIIrd Medical Department and Clinic, University Hospital Hamburg-Eppendorf
| | - Alexander Kreuter
- Dermatology, Venereology and Allergology, Helios St. Elisabeth Klinik Oberhausen
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff-Klinik GmbH, Bad Nauheim
| | - Alexander Nast
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
| | - Falk Ochsendorf
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt am Main
| | - Matthias Schneider
- Clinic and Functional Division for Rheumatology, University Hospital Düsseldorf
| | | | - Klaus Tenbrock
- Department of Pediatrics and Adolescent Medicine, University Hospital RWTH Aachen
| | - Jörg Wenzel
- Dermatological Department, University Hospital Bonn
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Abstract
Systemic lupus erythematosus is a chronic autoimmune disorder that causes a wide range of mild to life-threatening conditions that require hospitalization and critical care. The morbidity and mortality of systemic lupus erythematosus are associated with the organ system damage caused by intermittent or chronic disease activity and with the complications of long-term and toxic immunosuppressant medication regimens. This article reviews the epidemiologic, clinical, diagnostic, and therapeutic information essential for critical care clinicians who provide care to patients with systemic lupus erythematosus.
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Affiliation(s)
- Erin K Gasser
- Erin K. Gasser is Critical Care Nurse Practitioner at University of California, San Francisco Health, San Francisco, California
| | - Hildy M Schell-Chaple
- Hildy M. Schell-Chaple is Clinical Nurse Specialist at University of California, San Francisco Health and Clinical Professor, UCSF School of Nursing, 505 Parnassus Ave, L-976, San Francisco, CA 94143
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Jadhav P, Kulkarni T, Jadhav J, Desai S, Baviskar R. Levetiracetam-induced systemic lupus erythematosus. J R Coll Physicians Edinb 2021; 51:58-60. [PMID: 33877137 DOI: 10.4997/jrcpe.2021.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a rare autoimmune disorder in a physician's practice, commonly presenting in young females. It is rare for SLE to present at a late age. Though SLE is idiopathic, sometimes it can present as an adverse reaction to drugs. Quite a few drugs are implicated in this process. However, there are no reports of levetiracetam causing SLE. Here, we present a case of 62-year-old female presenting with SLE after consumption of levetiracetam for 1 year for her epilepsy. Erythematosus rash was her main symptom. This was associated with a strong positivity of antinuclear antibody. The symptoms remitted completely after the discontinuation of levetiracetam, suggesting them to be because of drug-induced lupus (DIL). DIL differs from SLE in being mild, affecting atypical age groups and resolving completely on withdrawal of the drug.
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Affiliation(s)
- Praveen Jadhav
- Omkar Rheumatology Clinic, Gaikwad Mala, Nasik Road, MH 422101, India,
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31
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Rao S, Sunkara A, Ashwath A, Srivastava N, Albert E. Lupus Cerebritis Refractory to Guideline-Directed Therapy: A Case Report. J Investig Med High Impact Case Rep 2021; 9:23247096211008708. [PMID: 33843326 PMCID: PMC8042542 DOI: 10.1177/23247096211008708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Systemic lupus erythematosus is an autoimmune disease that affects multiple organs and organ systems, subsequently requiring an elaborate regimen for management. We present the case of a 63-year-old female who developed unrelenting symptoms of drug-induced lupus, which persisted even after the offending agent was withdrawn, unmasking her underlying systemic lupus erythematosus. She continued to develop neuropsychiatric symptoms, including mania and hallucinations, which complicated the management of her disease. After exhausting the bank of anti-inflammatory and immunomodulators recommended by current guidelines, we found that a combination of rituximab infusions with thiothixene, an antipsychotic agent, significantly improved our patient’s neuropsychiatric symptoms. Further research should be conducted to determine the efficacy of rituximab in the treatment of resistant lupus cerebritis, and to validate the use of thiothixene in the management of neuropsychiatric symptoms secondary to lupus.
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Affiliation(s)
- Suman Rao
- SUNY Upstate Medical University, Syracuse, NY, USA
| | | | | | | | - Emily Albert
- SUNY Upstate Medical University, Syracuse, NY, USA
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32
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Apaydın H, Erten Ş. Tofacitinib-induced subacute cutaneous lupus erythematosus in a patient with rheumatoid arthritis. Mod Rheumatol Case Rep 2021; 5:254-258. [PMID: 33492185 DOI: 10.1080/24725625.2021.1877241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Tofacitinib is a Janus kinase inhibitor that is employed in the treatment of several diseases, especially rheumatoid arthritis (RA), to prevent joint damage and reduce disease activity. Drug-induced lupus erythematosus (DILE) is a disorder that is linked to some drugs and is characterised by regression of clinical signs and symptoms after discontinuation of the drug. A 56-year-old woman who was diagnosed with RA for 20 years was admitted to the rheumatology department. Tofacitinib tablet 10 mg/d was added to the patient's medical treatment. Three months after this medical treatment, the patient was diagnosed with drug-induced subacute cutaneous lupus erythematous (DISCLE) with erythematous skin lesions and autoantibody positivity. The skin rash, with increased autoantibodies, improved 6 months after discontinuation of tofacitinib. To the best of our knowledge, tofacitinib-induced lupus erythematous has not been previously reported. In this case, DILE developed after tofacitinib treatment in a patient who was followed up with RA.
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Affiliation(s)
- Hakan Apaydın
- Department of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Şükran Erten
- Department of Rheumatology, Ankara Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey
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33
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Hoque MR, Aviña‐Zubieta JA, De Vera MA, Qian Y, Esdaile JM, Xie H. Impact of Antimalarial Adherence on Mortality among Patients with Newly Diagnosed Systemic Lupus Erythematosus: A Population‐based Cohort Study. Arthritis Care Res (Hoboken) 2021; 74:1089-1097. [DOI: 10.1002/acr.24550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/08/2020] [Accepted: 12/22/2020] [Indexed: 11/07/2022]
Affiliation(s)
- M Rashedul Hoque
- Arthritis Research Canada Richmond Canada British Columbia
- Faculty of Health Sciences Simon Fraser University Burnaby Canada British Columbia
| | - J Antonio Aviña‐Zubieta
- Arthritis Research Canada Richmond Canada British Columbia
- Division of Rheumatology Department of Medicine University of British Columbia Vancouver Canada
| | - Mary A De Vera
- Arthritis Research Canada Richmond Canada British Columbia
- Faculty of Pharmaceutical Sciences University of British Columbia Vancouver Canada
| | - Yi Qian
- Sauder School of Business University of British Columbia Vancouver Canada
| | - John M Esdaile
- Arthritis Research Canada Richmond Canada British Columbia
- Division of Rheumatology Department of Medicine University of British Columbia Vancouver Canada
| | - Hui Xie
- Arthritis Research Canada Richmond Canada British Columbia
- Faculty of Health Sciences Simon Fraser University Burnaby Canada British Columbia
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34
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Reséndiz-Mora A, Wong-Baeza C, Nevárez-Lechuga I, Landa-Saldívar C, Molina-Gómez E, Hernández-Pando R, Wong-Baeza I, Escobar-Gutiérrez A, Baeza I. Interleukin 4 deficiency limits the development of a lupus-like disease in mice triggered by phospholipids in a non-bilayer arrangement. Scand J Immunol 2020; 93:e13002. [PMID: 33247472 DOI: 10.1111/sji.13002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/30/2020] [Accepted: 11/22/2020] [Indexed: 11/29/2022]
Abstract
Non-bilayer phospholipids arrangements (NPAs) are transient molecular associations different from lipid bilayers. When they become stable, they can trigger a disease in mice resembling human lupus, which is mainly characterized by the production of anti-NPA IgG antibodies. NPAs are stabilized on liposomes or cell bilayers by the drugs procainamide or chlorpromazine, which produce drug-induced lupus in humans. Here, we evaluated the participation of the TH 2 response, through its hallmark cytokine IL-4, on the development of the lupus-like disease in mice. Wild-type or IL-4 knockout BALB/c mice received liposomes bearing drug-induced NPAs, the drugs alone, or an anti-NPA monoclonal antibody (H308) to induce the lupus-like disease (the last two procedures stabilize NPAs on mice cells). IL-4 KO mice showed minor disease manifestations, compared to wild-type mice, with decreased production of anti-NPA IgG antibodies, no anti-cardiolipin, anti-histones and anticoagulant antibodies, and no kidney or skin lesions. In these mice, H308 was the only inducer of anti-NPA IgG antibodies. These findings indicate that IL-4 has a central role in the development of the murine lupus-like disease induced by NPA stabilization.
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Affiliation(s)
- Albany Reséndiz-Mora
- Laboratorio de Biomembranas, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México.,Laboratorio de Enzimología, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - Carlos Wong-Baeza
- Laboratorio de Biomembranas, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México.,Laboratorio de Enzimología, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - Irene Nevárez-Lechuga
- Laboratorio de Biomembranas, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México.,Laboratorio de Enzimología, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - Carla Landa-Saldívar
- Laboratorio de Biomembranas, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - Eréndira Molina-Gómez
- Laboratorio de Biomembranas, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México.,Laboratorio de Enzimología, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - Rogelio Hernández-Pando
- Sección de Patología Experimental, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México
| | - Isabel Wong-Baeza
- Laboratorio de Inmunología Molecular II, Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | | | - Isabel Baeza
- Laboratorio de Biomembranas, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
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35
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Examples of adverse effects after biological therapy. Postepy Dermatol Alergol 2020; 37:712-718. [PMID: 33240011 PMCID: PMC7675069 DOI: 10.5114/ada.2020.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 03/06/2019] [Indexed: 12/01/2022] Open
Abstract
Psoriasis is one of the most common, chronic skin diseases of as yet unexplained etiopathogenesis. In the recent years it has been proven that an immunological factor plays an important role in the dermatosis onset. This has led to introduction of biological drugs to the disease treatment regimen, which include, inter alia, adalimumab and ustekinumab. New therapy has become an alternative for patients with psoriasis resistant to standard treatment methods as well as an alternative form of treatment in case of occurrence of severe adverse drug reactions after administration of standard treatment. Despite good treatment results the administration of these drugs is associated with the occurrence of adverse reactions. This article presents cases of 4 patients who have been administered biological treatment and in whom there have been observed, inter alia, the occurrence of hypersensitivity reactions in the form of acute urticaria as well as skin lesions of erythema multiforme nature or positive antinuclear antibodies titre. The symptoms experienced by the presented patients posed no direct threat to life and the benefits of the drugs’ administration had a significant therapeutic importance.
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36
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Ashraf E, Ghouse AN, Siddiqui S, Siddiqui S, Khan Z. Discoid Lupus Erythematosus: A Cross-Sectional Study From the Sindh Institute of Skin Diseases, Karachi, Pakistan. Cureus 2020; 12:e11201. [PMID: 33269132 PMCID: PMC7704007 DOI: 10.7759/cureus.11201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Discoid lupus erythematosus (DLE) is the most common form of cutaneous lupus erythematosus. It is a chronic, scar-forming, photosensitive autoimmune dermatosis presenting with erythematous and scaly lesions. Predisposed areas include sun-exposed areas like the nose, forehead, and cheeks, as well as the upper body and extremities. The histological findings are typical, with interface dermatitis. Immunoglobulin M (IgM) and immunoglobulin G (IgG) are the most common deposits in the dermoepidermal junction of the involved skin. The most common treatments used are sunscreens, topical corticosteroids, and antimalarials. Immunosuppressive agents, thalidomide, dapsone, and retinoids can be used in refractory cases. The aim of this study was to study the clinicopathologic patterns of DLE in patients presenting to the Institute of Skin Diseases in Sindh, Karachi. Methods A total of 53 consecutive patients with DLE meeting the inclusion criteria were evaluated between February 18, 2018 to March 2, 2019 at the Institute of Skin Diseases. Patients with clinical suspicion of DLE were evaluated and studied prospectively after written informed consent was obtained. Information was then collected from their medical histories, physical examination records, and laboratory investigation reports. Results A total of 53 consecutive patients with clinical and/or histological diagnosis of DLE was included in this study, out of which 75.5% (40) were females with a male to female ratio of 1:3.1. The mean age of the patients at the time of presentation was 36.02 ± 10.04 years, ranging from 14 to 65 years. More than half of the patients (35, 66.0%) were under 40 years of age and 20.8% (11) had a positive family history of DLE. DLE was localized in 36 patients (67.9%) and exposure to the ultraviolet radiation (UVR) was found to be the most frequent induced factor in 46 patients (86.8%), followed by stress which was observed in 14 patients (26.4%). The distribution of commonly affected sites were the face (81.1%), the limbs (71.7%), and the scalp (48.4%) of the patients. Serology antinuclear antibody (ANA) was positive in 56.6% and serology anti-double-stranded deoxyribonucleic acid antibodies (anti-dsDNA) were positive in 45.3% of patients. Smoking, as an induced factor, was more commonly observed among male patients as compared to the female patients with a proportion of 53.8% vs. 2.5%, p < 0.001, while stress was more common among female patients with a proportion of 35% vs. 0%, p = 0.013, respectively. Histopathology with direct immunofluorescence was done in 33 cases which included cases with negative serology or where the diagnosis was in doubt clinically. The main histopathological features observed were periadnexal and perivascular dermal infiltrates, basal cells vacuolization, epidermal atrophy, hyperkeratosis, and follicular plugging. The commonest morphological form observed was the classic discoid plaque form. Conclusion Clinical patterns of DLE in our population comprises of female dominance. Exposure to UVR was the leading inducing factor. The face and limbs were the most commonly involved sites, and the majority of the patients had localized DLE with positive ANA in more than half of those patients. The importance of limiting ultraviolet radiation exposure and toxins (drugs and smoking) should be emphasized in our population.
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Affiliation(s)
- Erum Ashraf
- Dermatology, Institute of Skin Diseases Sindh, Karachi, PAK
| | | | | | - Sana Siddiqui
- Dermatology, Memon Medical Institute Hospital, Karachi, PAK
| | - Zara Khan
- Dermatology, Medical Glamor Clinics, Riyadh, SAU
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37
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Collins KS, Raviele ALJ, Elchynski AL, Woodcock AM, Zhao Y, Cooper-DeHoff RM, Eadon MT. Genotype-Guided Hydralazine Therapy. Am J Nephrol 2020; 51:764-776. [PMID: 32927458 DOI: 10.1159/000510433] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/24/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite its approval in 1953, hydralazine hydrochloride continues to be used in the management of resistant hypertension, a condition frequently managed by nephrologists and other clinicians. Hydralazine hydrochloride undergoes metabolism by the N-acetyltransferase 2 (NAT2) enzyme. NAT2 is highly polymorphic as approximately 50% of the general population are slow acetylators. In this review, we first evaluate the link between NAT2 genotype and phenotype. We then assess the evidence available for genotype-guided therapy of hydralazine, specifically addressing associations of NAT2 acetylator status with hydralazine pharmacokinetics, antihypertensive efficacy, and toxicity. SUMMARY There is a critical need to use hydralazine in some patients with resistant hypertension. Available evidence supports a significant link between genotype and NAT2 enzyme activity as 29 studies were identified with an overall concordance between genotype and phenotype of 92%. The literature also supports an association between acetylator status and hydralazine concentration, as fourteen of fifteen identified studies revealed significant relationships with a consistent direction of effect. Although fewer studies are available to directly link acetylator status with hydralazine antihypertensive efficacy, the evidence from this smaller set of studies is significant in 7 of 9 studies identified. Finally, 5 studies were identified which support the association of acetylator status with hydralazine-induced lupus. Clinicians should maintain vigilance when prescribing maximum doses of hydralazine. Key Messages: NAT2 slow acetylator status predicts increased hydralazine levels, which may lead to increased efficacy and adverse effects. Caution should be exercised in slow acetylators with total daily hydralazine doses of 200 mg or more. Fast acetylators are at risk for inefficacy at lower doses of hydralazine. With appropriate guidance on the usage of NAT2 genotype, clinicians can adopt a personalized approach to hydralazine dosing and prescription, enabling more efficient and safe treatment of resistant hypertension.
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Affiliation(s)
- Kimberly S Collins
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Anthony L J Raviele
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amanda L Elchynski
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, Florida, USA
| | - Alexander M Woodcock
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yang Zhao
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, Florida, USA
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, Florida, USA
| | - Michael T Eadon
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA,
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38
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Jang DH, Lee JI, Bae JY, Jung HJ, Park MY, Ahn J. Facial erythema after the treatment of dupilumab in SLE patient. Allergy Asthma Clin Immunol 2020; 16:60. [PMID: 32944024 PMCID: PMC7491356 DOI: 10.1186/s13223-020-00458-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/26/2020] [Indexed: 11/27/2022] Open
Abstract
Background Dupilumab is a receptor antagonist binding to the alpha subunit of the interleukin-4 receptor. Through binding to it, dupilumab inhibits signaling of both IL-4 and IL-13, the representative Th2 biomarkers. Recently, in addition to the treatment effects for atopic dermatitis (AD), there is an emerging adverse event as facial erythema. Case presentation A twenty-seven-year-old female patient developed erythema and desquamation on the face and neck after dupilumab administration. She had AD on her arms, legs, and trunk before the treatment but there was no atopic clinical feature in her face and neck. With the treatment of dupilumab, her skin lesions of the body have improved from the beginning of the treatment. In the patch test, including dupilumab, there was no specific finding other than the 1+ response to neomycin on day 2. In the intradermal test to dupilumab, a positive result was observed 15 min later, but negative both days 1 and 2. The blood examination showed an elevation of both ANA as 1:80 and anti-phospholipid antibodies (Anti-cardiolipin IgM, IgG, and Anti- beta 2 GPI IgG). She was diagnosed with Systemic lupus erythematosus (SLE) based on diagnostic criteria by a rheumatologist. Conclusion Dupilumab is an emerging therapeutic agent for AD, and treatment cases are increasing in Korea. However, there are several adverse events during the treatment of dupilumab. Herein, we report the unexpected adverse event during the treatment of dupilumab in SLE patients.
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Affiliation(s)
- Dong Hyek Jang
- Department of Dermatology, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564 Korea
| | - Jae In Lee
- Department of Dermatology, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564 Korea
| | - Joo Yoon Bae
- Department of Dermatology, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564 Korea
| | - Hye Jung Jung
- Department of Dermatology, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564 Korea
| | - Mi Yeon Park
- Department of Dermatology, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564 Korea
| | - Jiyoung Ahn
- Department of Dermatology, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564 Korea
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39
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McNamara K, Hughes OB, Strowd LC. Cutaneous drug eruptions including serum sickness-like reaction, symmetrical drug-related intertriginous and flexural exanthema, and drug-induced lupus. Clin Dermatol 2020; 38:641-647. [PMID: 33341198 DOI: 10.1016/j.clindermatol.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cutaneous manifestations of drug reactions are common yet vary widely in their appearance and degree of internal organ involvement. Serum sickness--like reactions, symmetrical drug-related intertriginous and flexural exanthem, granulomatous drug eruption, pseudolymphoma, and drug-induced lupus are medication-induced conditions with dermatologic presentations. Many of the conditions discussed are relatively rare but nonetheless demand our attention and understanding. Some of the conditions presented may be more likely encountered in the hospital setting, as is the case with serum sickness-like reactions and drug-induced lupus, whereas others may present to outpatient clinic for diagnosis. Given the similarities in clinical history of patients presenting with these conditions, an understanding of the clinical presentation, pathophysiology, culprit medications, histologic appearance, and serologic characteristics is warranted to correctly diagnose and manage these uncommon adverse reactions. We also discuss how to differentiate some of these conditions from more serious mimickers, as in the case of pseudolymphoma drug reaction mimicking a true lymphoma and drug-induced lupus mimicking acute systemic lupus erythematosus.
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Affiliation(s)
- Kyle McNamara
- Wake Forest University School of Medicine, Department of Dermatology, Winston-Salem, North Carolina, USA
| | - Olivia Bosshardt Hughes
- Wake Forest University School of Medicine, Department of Dermatology, Winston-Salem, North Carolina, USA
| | - Lindsay Chaney Strowd
- Wake Forest University School of Medicine, Department of Dermatology, Winston-Salem, North Carolina, USA.
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40
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Abstract
BACKGROUND Treatment of drug susceptible tuberculosis (DS-TB) requires regimens containing first line drugs (FLDs') whereas drug resistant tuberculosis (DR-TB) are treated with regimens comprising combination of both second line drugs (SLDs') and few FLDs'. Adverse drug reactions (ADRs') to these anti-tubercular drugs are quite common as they are being used for longer duration. ADRs' may cause associated morbidity and even mortality if not recognized early. There are major concerns regarding treatment of DR-TB patients particularly with SLDs' in that they are expensive, have low efficacy and more toxic as compared to FLDs'. There may be a severe impact on adherence and higher risk of default and treatment failure affecting outcome overall if such ADRs' are not properly managed. METHODS A search strategy was adopted involving principal electronic databases (Pubmed, EMBASE, Google and Google scholar) of English language articles from 1990 till now, using various terms in combination. All articles with resulting titles, abstract and full text, when available were read and kept for reference. RESULTS 101 articles including 4 systematic reviews have been identified. The overall prevalence of ADRs' with FLDs' and SLDs' are estimated to vary from 8.0% to 85% and 69% to 96% respectively. Most ADRs' are observed in the intensive phase as compared to continuation phase. No difference in frequency of ADRs' was reported with intermittent or daily intake of anti-tubercular drugs. The occurrence of ADRs' may be influenced by multiple factors and may range from mild gastrointestinal disturbances to serious hepatotoxicity, ototoxicity, nephrotoxicity peripheral neuropathy, cutaneous ADRs', etc. Most of ADRs' are minor and can be managed without discontinuation of treatment. Some ADRs' can be major or severe causing life-threatening experience leading to either modification or discontinuation of regimen and even mortality if not recognized and treated promptly. CONCLUSION Early recognition by active surveillance and appropriate management of these ADRs' might improve adherence and treatment success.
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Affiliation(s)
- Rajendra Prasad
- Era's Lucknow Medical College & Hospital, Lucknow, Uttar Pradesh, 226003, India.
| | - Abhijeet Singh
- Department of Pulmonary, Critical Care & Sleep Medicine, VMMC and Safdarjung Hospital, New Delhi, 110029, India
| | - Nikhil Gupta
- Department of General Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226010, India
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41
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Aghdashi M, Salami S, Nezhadisalami A. Evaluation of the serum β2 Microglobulin level in patients with systemic lupus erythematosus and its correlation with disease activity. Biomedicine (Taipei) 2019; 9:16. [PMID: 31453797 PMCID: PMC6711321 DOI: 10.1051/bmdcn/2019090316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/09/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Designation of disease activity is serious for the management of systemic lupus erythematosus (SLE). Serum level of β2 microglobulin (β2M) may be associated with illness activity in SLE disease. Since the role of β2M for assessing of illness activity in SLE is not completely clear, the current study aimed to discern evaluation of β2M in patients with SLE and its correlation with sickness activity. MATERIALS AND METHODS In this case-control study, 50 patients with SLE disease and 25 healthy individuals were selected in Imam Khomeini Hospital in central of Urmia. Blood samples were collected safely from patients, serum was removed, and β2M measured using an ELISA method. The results for other parameters including C reactive protein, C3, C4, anti dsDNA and erythrocyte sedimentation rate were obtained from patients' medical record. Data analyzed using appropriate statistical tests including Mann-Whitney U test, Independent f-test, Kruskal-Wallis, and Spearman used for analysis of data. RESULTS In the current study, a significant difference was seen between two groups in terms of β2M (p < 0.001). Remarkable correlation was seen between the level of β2M with disease activity (p < 0.001). Furthermore, there are significant relevancy between the level of β2M with 24-hour urine protein, ESR, disease activity score, and CRP (p < 0.05). CONCLUSION The results revealed that serum amount of β2M in SLE patients is higher compared to healthy ones, which is significantly correlated to score of illness activity, CRP, and ESR in patients with SLE disease. Hence β2M might be an excellent serological marker helping the prediction of sickness activity and inflammation in SLE patients.
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Affiliation(s)
| | - Simak Salami
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Shahid Beheshti University of Medical Sciences Tehran Iran
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42
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Rahman MF, Panezai MA, Szerlip HM. Hydralazine-induced pericardial effusion. Proc (Bayl Univ Med Cent) 2019; 32:377-378. [DOI: 10.1080/08998280.2019.1613331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
| | | | - Harold M. Szerlip
- Division of Nephrology, Baylor University Medical Center, Dallas, Texas
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43
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Teoh L, Moses G, McCullough MJ. A review and guide to drug-associated oral adverse effects-Oral mucosal and lichenoid reactions. Part 2. J Oral Pathol Med 2019; 48:637-646. [PMID: 31241804 DOI: 10.1111/jop.12910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 01/02/2023]
Abstract
Dental practitioners and other health professionals commonly encounter and manage adverse medicine effects that manifest in the orofacial region. Numerous medicines are associated with a variety of oral adverse effects. However, due to lack of awareness and training, these side effects are not always associated with medicine use and are underreported to pharmacovigilance agencies by dentists and other health professionals. This article aims to inform health professionals about the various oral adverse effects that can occur and the most commonly implicated drugs to improve the management, recognition and reporting of adverse drug effects. This article follows on from Part 1; however, the focus here is on lichenoid reactions and oral mucosal disorders including oral aphthous-like ulceration, mucositis and bullous disorders such as drug-induced pemphigus, pemphigoid, Stevens-Johnson syndrome and toxic epidermal necrolysis.
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Affiliation(s)
- Leanne Teoh
- Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
| | - Geraldine Moses
- School of Pharmacy, University of Queensland, Woolloongabba, Queensland, Australia
| | - Michael J McCullough
- Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
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44
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Jarrett P, Werth VP. A review of cutaneous lupus erythematosus: improving outcomes with a multidisciplinary approach. J Multidiscip Healthc 2019; 12:419-428. [PMID: 31213824 PMCID: PMC6549666 DOI: 10.2147/jmdh.s179623] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/03/2019] [Indexed: 12/20/2022] Open
Abstract
Cutaneous lupus erythematosus encompasses a spectrum of cutaneous disease with different phenotypes, and it potentially intersects with many disciplines in medicine. This review examines the epidemiology, clinical subtypes, pathology, psychology and intervention options for this disorder. It is important to understand the psychological distress that cutaneous lupus can cause and if needed actively investigate this possibility with the patient. Careful liaison between disciplines will achieve the optimum outcome.
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Affiliation(s)
- Paul Jarrett
- Department of Dermatology, Middlemore Hospital, Auckland, New Zealand.,Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - Victoria P Werth
- Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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45
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Prenner A, Blum R, Beltraminelli H, Stirnimann G, Borradori L. Subacute cutaneous lupus erythematosus triggered by an antiviral treatment combination for hepatitis C virus infection. J Eur Acad Dermatol Venereol 2018; 33:e129-e131. [DOI: 10.1111/jdv.15330] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A. Prenner
- Department of Dermatology Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - R. Blum
- Department of Dermatology Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - H. Beltraminelli
- Department of Dermatology Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - G. Stirnimann
- University Clinic for Visceral Surgery and Medicine Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - L. Borradori
- Department of Dermatology Inselspital Bern University Hospital University of Bern Bern Switzerland
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46
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Ribero S, Sciascia S, Borradori L, Lipsker D. The Cutaneous Spectrum of Lupus Erythematosus. Clin Rev Allergy Immunol 2018; 53:291-305. [PMID: 28752372 DOI: 10.1007/s12016-017-8627-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Systemic lupus erythematosus is a complex autoimmune disease with a wide spectrum of clinical and immunopathological features. Cutaneous and articular manifestations are the most common signs in patients with systemic lupus erythematosus. We here review the pathogenesis and the new classification of cutaneous lupus erythemathosus with a discussion of the significance of the various cutaneous signs. The lesions are classified according to the level of the cellular infiltrate and tissue damage in the epidermis, dermis, and/or subcutis. Furthermore, cutaneous lesions pointing to the presence of a thrombotic vasculopathy and those due to a distinct inflammatory, neutrophilic-mediated reaction pattern are highlighted. Particular attention will be given in describing the histology of skin manifestation. Treatment options for cutaneous lupus erythemathosus have increased with the introduction of new biological therapies. However, the majority of the patients still benefit from antimalarials, which remain the cornerstone of treatment. The evaluation and management of cutaneous lupus erythemathosus patients depend on the clinical findings and associated symptoms.
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Affiliation(s)
- Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy.
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases- Department of Clinical and Biological Sciences, University of Turin, San Giovanni Hospital, Turin, Italy
| | - Luca Borradori
- Department of Dermatology, University of Bern, Inselspital, Berne, Switzerland
| | - Dan Lipsker
- Dermatologic Clinic, Faculty of Medicine, University of Strasbourg, Strasbourg, France
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Yamaga R, Tezuka K, Sugawara S, Watanabe T, Hirai I, Suzuki T, Kimura W. S-1 induced discoid lupus erythematosus-like lesions and long-term complete response for para-aortic lymph node recurrence of pancreatic ductal adenocarcinoma: a case report. Surg Case Rep 2018; 4:52. [PMID: 29882080 PMCID: PMC5991108 DOI: 10.1186/s40792-018-0460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background Metastatic recurrence after resection of pancreatic cancer is considered to be an incurable disease, and discoid lupus erythematosus (DLE)-like lesions are known as a side effect of fluorouracil agents. We report a very rare case of metastatic recurrence of pancreatic cancer in a Japanese man with DLE-like lesions in which long-term complete response was achieved through S-1 monotherapy. Case presentation A 65-year-old man who had undergone distal pancreatectomy with splenectomy for pancreatic body cancer and had received adjuvant gemcitabine developed postoperative para-aortic lymph node recurrence 17 months after surgery. S-1 monotherapy was started. About 2 weeks after starting this treatment, he developed an erythematous rash on the face and scalp. DLE was diagnosed by skin biopsy. The eruptions were aggravated by the administration of S-1 and improved during periods of respite from S-1. Yet as CA19-9 was reduced by almost half 1 month after starting S-1 chemotherapy, S-1 chemotherapy was continued at a reduced dose. CA19-9 decreased to within a normal range within 6 months after starting S-1 chemotherapy, and a reduction in lymph node metastasis was detected through imaging. The patient is still alive without recurrence or metastasis 113 months after surgery. Conclusions Even in patients with S-1-induced DLE-like lesions, continuation of S-1 is possible if the dose and duration of S-1 are appropriately regulated and medical therapy is administered for the skin lesions. Further investigation into the possible correlation between skin rash and clinical benefit in connection with S-1 is strongly warranted.
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Affiliation(s)
- Ryosuke Yamaga
- First Department of Surgery, Graduate School of Medical Science, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Koji Tezuka
- First Department of Surgery, Graduate School of Medical Science, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Shuichiro Sugawara
- First Department of Surgery, Graduate School of Medical Science, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Toshihiro Watanabe
- First Department of Surgery, Graduate School of Medical Science, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Ichiro Hirai
- First Department of Surgery, Graduate School of Medical Science, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Tamio Suzuki
- Department of Dermatology, Graduate School of Medical Science, Yamagata University, Yamagata, Japan
| | - Wataru Kimura
- First Department of Surgery, Graduate School of Medical Science, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
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48
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Klecka M, Thybo C, Macaubas C, Solov'yov I, Simard J, Balboni IM, Fox E, Voss A, Mellins ED, Astakhova K. Autoantibody Profiling in Lupus Patients using Synthetic Nucleic Acids. Sci Rep 2018; 8:5554. [PMID: 29615791 PMCID: PMC5883037 DOI: 10.1038/s41598-018-23910-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/19/2018] [Indexed: 02/08/2023] Open
Abstract
Autoantibodies to nuclear components of cells (antinuclear antibodies, ANA), including DNA (a-DNA), are widely used in the diagnosis and subtyping of certain autoimmune diseases, including systemic lupus erythematosus (SLE). Despite clinical use over decades, precise, reproducible measurement of a-DNA titers remains difficult, likely due to the substantial sequence and length heterogeneity of DNA purified from natural sources. We designed and tested a panel of synthetic nucleic acid molecules composed of native deoxyribonucleotide units to measure a-DNA. ELISA assays using these antigens show specificity and reproducibility. Applying the ELISA tests to serological studies of pediatric and adult SLE, we identified novel clinical correlations. We also observed preferential recognition of a specific synthetic antigen by antibodies in SLE sera. We determined the probable basis for this finding using computational analyses, providing valuable structural information for future development of DNA antigens. Synthetic nucleic acid molecules offer the opportunity to standardize assays and to dissect antibody-antigen interactions.
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Affiliation(s)
- Martin Klecka
- Department of Chemistry, Technical University of Denmark, Kemitorvet 206, 2800, Kgs, Lyngby, Denmark
| | - Christina Thybo
- Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Claudia Macaubas
- Department of Pediatrics, Program in Immunology, Stanford University School of Medicine, 269 Campus Drive, Stanford, California, 94305, USA
| | - Ilia Solov'yov
- Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Julia Simard
- Department of Health and Research Policy, Stanford University School of Medicine, 150 Governor's Lane, Stanford, California, 94305, USA
| | - Imelda Maria Balboni
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Stanford University, 700 Welch Rd. Suite 301, Stanford, California, 94304, USA
| | - Emily Fox
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Stanford University, 700 Welch Rd. Suite 301, Stanford, California, 94304, USA
| | - Anne Voss
- Department of Rheumatology, Odense University Hospital, J. B. Winsløws Vej 19, 2, 5000, Odense C, Denmark
| | - Elizabeth D Mellins
- Department of Pediatrics, Program in Immunology, Stanford University School of Medicine, 269 Campus Drive, Stanford, California, 94305, USA.
| | - Kira Astakhova
- Department of Chemistry, Technical University of Denmark, Kemitorvet 206, 2800, Kgs, Lyngby, Denmark.
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49
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Jácome Sánchez EC, García Castillo MA, González VP, Guillén López F, Correa Díaz EP. Coexistence of systemic lupus erythematosus and multiple sclerosis. A case report and literature review. Mult Scler J Exp Transl Clin 2018; 4:2055217318768330. [PMID: 29662683 PMCID: PMC5894926 DOI: 10.1177/2055217318768330] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/01/2018] [Accepted: 03/08/2018] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis (MS) and systemic lupus erythematous (SLE) are autoimmune diseases, the coexistence of which is uncommon in patients. Owing to the rarity of this condition, the distinction between MS and SLE is a diagnostic challenge for neurologists. We present a case report in which MS and SLE were present in the same patient. There are few case reports in the world on the association between MS and SLE. The following case report is the first of its kind in which both MS and SLE are present in a patient from a country with low prevalence of MS such as Ecuador.
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Affiliation(s)
| | | | | | - Fernando Guillén López
- Department of Neurology, Hospital José Carrasco de Cuenca, Popayán y Pacto Andino, Ecuador
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50
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Didier K, Bolko L, Giusti D, Toquet S, Robbins A, Antonicelli F, Servettaz A. Autoantibodies Associated With Connective Tissue Diseases: What Meaning for Clinicians? Front Immunol 2018; 9:541. [PMID: 29632529 PMCID: PMC5879136 DOI: 10.3389/fimmu.2018.00541] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/02/2018] [Indexed: 02/06/2023] Open
Abstract
Connective tissue diseases (CTDs) such as systemic lupus erythematosus, systemic sclerosis, myositis, Sjögren's syndrome, and rheumatoid arthritis are systemic diseases which are often associated with a challenge in diagnosis. Autoantibodies (AAbs) can be detected in these diseases and help clinicians in their diagnosis. Actually, pathophysiology of these diseases is associated with the presence of antinuclear antibodies. In the last decades, many new antibodies were discovered, but their implication in pathogenesis of CTDs remains unclear. Furthermore, the classification of these AAbs is nowadays misused, as their targets can be localized outside of the nuclear compartment. Interestingly, in most cases, each antibody is associated with a specific phenotype in CTDs and therefore help in better defining either the disease subtypes or diseases activity and outcome. Because of recent progresses in their detection and in the comprehension of their pathogenesis implication in CTD-associated antibodies, clinicians should pay attention to the presence of these different AAbs to improve patient's management. In this review, we propose to focus on the different phenotypes and features associated with each autoantibody used in clinical practice in those CTDs.
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Affiliation(s)
- Kevin Didier
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France
| | - Loïs Bolko
- Rheumatology Department, Maison Blanche Hospital, Reims University Hospitals, Reims, France
| | - Delphine Giusti
- Laboratory of Dermatology, Faculty of Medicine, EA7319, University of Reims Champagne-Ardenne, Reims, France.,Laboratory of Immunology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Segolene Toquet
- Department of Internal Medicine, CHU de Reims, Reims, France
| | - Ailsa Robbins
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France
| | - Frank Antonicelli
- Laboratory of Dermatology, Faculty of Medicine, EA7319, University of Reims Champagne-Ardenne, Reims, France.,Department of Biological Sciences, Immunology, UFR Odontology, University of Reims Champagne-Ardenne, Reims, France
| | - Amelie Servettaz
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France.,Laboratory of Dermatology, Faculty of Medicine, EA7319, University of Reims Champagne-Ardenne, Reims, France
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