1
|
Steele L, Pyne D, Jeetle S, Cunningham M, Goldsmith P, Dhoat S, Kelly S, Goiriz R. Erythema multiforme-like lesions in a patient with systemic lupus erythematosus progressing to toxic epidermal necrolysis-like lupus. Clin Exp Dermatol 2023; 48:1205-1207. [PMID: 37335969 DOI: 10.1093/ced/llad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023]
Abstract
A 34-year-old woman of African ancestry had a diagnosis of systemic lupus erythematosus that was antinuclear antibodies (> 1 : 640, speckled), anti-U1-ribonucleoprotein, anti-Smith and anti-C1q positive. She presented to hospital with severely painful annular and polycyclic erosions, some with a targetoid-like appearance. After 6 weeks she developed slowly evolving dusky papules/plaques and flaccid bullae, suggestive of toxic epidermal necrolysis-like lupus, and was successfully treated with intravenous rituximab and intravenous immunoglobulin (2 g kg–1 over 3 days).
Collapse
Affiliation(s)
- Lloyd Steele
- Departments of Dermatology
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | | | - Sharanpal Jeetle
- Histopathology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | | | | | - Stephen Kelly
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | | |
Collapse
|
2
|
Vale ECSD, Garcia LC. Cutaneous lupus erythematosus: a review of etiopathogenic, clinical, diagnostic and therapeutic aspects. An Bras Dermatol 2023; 98:355-372. [PMID: 36868923 PMCID: PMC10173173 DOI: 10.1016/j.abd.2022.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/03/2022] [Accepted: 09/12/2022] [Indexed: 03/05/2023] Open
Abstract
Cutaneous lupus erythematosus is an autoimmune disease of varied clinical expression, which may present as an exclusively cutaneous disease or be one of the multiple manifestations of systemic lupus erythematosus. Its classification includes acute, subacute, intermittent, chronic and bullous subtypes, which are usually identified based on clinical features and histopathological and laboratory findings. Other non-specific cutaneous manifestations may be associated with systemic lupus erythematosus and are usually related to disease activity. Environmental, genetic and immunological factors play a role in the pathogenesis of skin lesions in lupus erythematosus. Recently, considerable progress has been made in elucidating the mechanisms involved in their development, which allows for foreseeing future targets for more effective treatments. This review proposes to discuss the main etiopathogenic, clinical, diagnostic and therapeutic aspects of cutaneous lupus erythematosus, aiming to update internists and specialists from different areas.
Collapse
Affiliation(s)
| | - Lucas Campos Garcia
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| |
Collapse
|
3
|
Drenovska K, Shahid M, Mateeva V, Vassileva S. Case Report: Rowell Syndrome-Like Flare of Cutaneous Lupus Erythematosus Following COVID-19 Infection. Front Med (Lausanne) 2022; 9:815743. [PMID: 35237629 PMCID: PMC8882728 DOI: 10.3389/fmed.2022.815743] [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: 11/15/2021] [Accepted: 01/14/2022] [Indexed: 11/30/2022] Open
Abstract
The current COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had an important impact on dermatology practice, posing diagnostic and therapeutic challenges especially in patients with inflammatory and autoimmune skin disorders. Disease-specific and nonspecific cutaneous manifestations have been increasingly reported in the spectrum of COVID-19 but the influence of the infection on pre-existing dermatologic diseases has not been clearly defined. There has been a debate in the literature as to whether patients suffering from autoimmune dermatoses, including cutaneous lupus erythematosus (CLE), are at increased risk of SARS-CoV-2 infection, as well as if they experience worsening of their lupus erythematosus (LE)-related clinical symptoms. This article reports on a case of Rowell syndrome occurring after COVID-19 in a 67-year old woman with pre-existing chronic CLE manifesting with few discoid lesions on the face, scalp, and upper chest, successfully controlled with topical corticosteroids and photoprotection. Erythema multiforme (EM)-like eruption developed approximately two weeks after the SARS-CoV-2 infection, the latter being confirmed by positive nasopharyngeal swab and successfully treated with systemic antibiotics and antiaggregants. Diffuse hair loss and patches of cicatricial alopecia were also present upon scalp examination. Laboratory workup, including routine tests, histologic, immunofluorescent, and serologic investigations, was supportive to the diagnosis. Administration of topical and systemic corticosteroids along with peroral hydroxychloroquine resulted in the progressive improvement of the cutaneous lesions. Rowell syndrome is a rare entity in the spectrum of LE, characterized by EM-like lesions, photosensitivity, and positive antinuclear and anti-Ro antibodies, that is currently considered to be a variant of subacute CLE (SCLE). Several cases of SCLE have been described in association with medications, including anti-SARS-CoV-2 vaccines but only a few reports incriminate the infection itself as a potential exacerbating factor. Based on the clinical course of the disease, we suggest that the observed Rowell syndrome-like flare of CLE was related to the COVID-19 infection in this patient.
Collapse
Affiliation(s)
- Kossara Drenovska
- Department of Dermatology and Venereology, Medical University-Sofia, Sofia, Bulgaria
| | | | | | | |
Collapse
|
4
|
Sethy M, Padhan P, Abirami C, Maikap D. Rowell's Syndrome: A Case Report and Literature Overview. Indian Dermatol Online J 2021; 12:608-610. [PMID: 34430473 PMCID: PMC8354387 DOI: 10.4103/idoj.idoj_554_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/28/2020] [Accepted: 10/05/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Mitanjali Sethy
- Department of Dermatology, Venereology and Leprosy, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India
| | - Prasanta Padhan
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India
| | - C Abirami
- Department of Dermatology, Venereology and Leprosy, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India
| | - Debashis Maikap
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India
| |
Collapse
|
5
|
Utilization of Rituximab for Refractory Rowell Syndrome. Case Rep Rheumatol 2021; 2021:2727382. [PMID: 34367710 PMCID: PMC8342167 DOI: 10.1155/2021/2727382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022] Open
Abstract
Rowell syndrome describes the occurrence of erythema multiforme-like lesions in patients with cutaneous lesions of lupus erythematosus. The clinical picture of atypical erythema multiforme-like lesions, presence of chilblains, speckled ANA pattern, anti-Ro/SSA, or anti-La/SSB antibodies, and absence of infectious or pharmacologic triggers in a patient with systemic lupus erythematosus are some of the classic clinical and serologic features. Histopathologic and serologic findings can help differentiate this process from erythema multiforme. We present a case of young woman with systemic lupus erythematosus, end-stage renal disease due to lupus nephritis, and a remote history of Steven–Johnson syndrome due to sulfa allergy who presented to the hospital with a recurrent, progressive, targetoid erythematous rash involving more than 60% of her body surface area. Our patient had several hospitalizations in the recent past for this erythematous rash and had failed oral therapy with prednisone 1 mg/kg and hydroxychloroquine. In view of the minimal improvement and increasing severity and patient exhibiting early features of mast cell activation syndrome, the patient was treated with pulse intravenous glucocorticoids followed by rituximab with an excellent response. We highlight a unique case report of progressive Rowell syndrome refractory to standard of care with an excellent response to rituximab.
Collapse
|
6
|
Bitar C, Menge TD, Chan MP. Cutaneous manifestations of lupus erythematosus: A practical clinicopathologic review for pathologists. Histopathology 2021; 80:233-250. [PMID: 34197657 DOI: 10.1111/his.14440] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
Accurate diagnosis of connective tissue diseases is often challenging and relies on careful correlation between clinical and histopathologic features, direct immunofluorescence studies, and laboratory workup. Lupus erythematosus (LE) is a prototype of connective tissue disease with a variety of cutaneous and systemic manifestations. Microscopically, cutaneous LE is classically characterized by an interface dermatitis, although other histopathologic patterns also exist depending on the clinical presentation, location, and chronicity of the skin lesions. In this article, we review the clinical, serologic, histopathologic, and direct immunofluorescence findings in LE-specific and LE-nonspecific skin lesions, with an emphasis on lesser known variants, newly described features, and helpful ancillary studies. This review will guide general pathologists and dermatopathologists in accurately diagnosing and subclassifying cutaneous LE.
Collapse
Affiliation(s)
- Carole Bitar
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tyler D Menge
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - May P Chan
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
7
|
Nonhoff J, Ottmann K, Tronnier M. Rowell-Syndrom bei subakut-kutanem Lupus erythematodes. AKTUELLE DERMATOLOGIE 2021. [DOI: 10.1055/a-1341-4447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungWir berichten über einen 77-jährigen Patienten mit akut aufgetretenen, kokardenartig anmutenden Hautveränderungen bei vorbekanntem subakut-kutanem Lupus erythematodes.Aufgrund der Befundkonstellation mit fein-gesprenkelten antinukleären Antikörpern, Antikörpern gegen Ro/SSA und La/SSB und einem positiven Rheumafaktor wurde in Zusammenschau mit der Histologie die Diagnose eines Rowell-Syndroms gestellt. Das Rowell-Syndrom beschreibt das Auftreten Erythema-exsudativum-multiforme-artiger Hautveränderungen bei Patienten mit vorbekanntem Lupus erythematodes.Die diagnostischen Herausforderungen bei der Diagnosestellung des Rowell-Syndroms in Abgrenzung zur Koinzidenz von Lupus erythematodes mit einem Erythema exsudativum multiforme werden anhand einer weiteren Fallbeschreibung einer 44-jährigen Patientin mit vorbekanntem subakut-kutanem Lupus erythematodes veranschaulicht.
Collapse
Affiliation(s)
- J. Nonhoff
- Klinik für Dermatologie, Venerologie und Allergologie, Helios Klinikum Hildesheim
| | - K. Ottmann
- Klinik für Dermatologie, Venerologie und Allergologie, Helios Klinikum Hildesheim
| | - M. Tronnier
- Klinik für Dermatologie, Venerologie und Allergologie, Helios Klinikum Hildesheim
| |
Collapse
|
8
|
Kadiru RA, Hegde SP, Mithun HK, Rao AC. Neuropsychiatric manifestations in an adolescent male with Rowell syndrome. J Postgrad Med 2021; 67:109-112. [PMID: 33835061 PMCID: PMC8253327 DOI: 10.4103/jpgm.jpgm_879_20] [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] [Indexed: 12/03/2022] Open
Abstract
A 15-year-old boy presented with fever, skin, and oral lesions for 4 weeks. The cutaneous lesions were suggestive of subacute cutaneous lupus erythematosus and erythema multiforme. His clinical, histopathological, and immunological features were indicative of Rowell syndrome and he satisfied the diagnostic criteria of Rowell syndrome proposed by Zeitouni et al. He subsequently developed neurological manifestations and was diagnosed to have neuropsychiatric systemic lupus erythematosus. We report this case for the unusual occurrence of a rare entity like Rowell syndrome in an adolescent male with co-existence of neuropsychiatric systemic lupus erythematosus.
Collapse
Affiliation(s)
- R A Kadiru
- Department of Dermatology, Venereology and Leprosy, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - S P Hegde
- Department of Dermatology, Venereology and Leprosy, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - H K Mithun
- Department of Paediatrics, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - A C Rao
- Department of Pathology, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| |
Collapse
|
9
|
Chandra A, Saha SK, Ray AK, Karmakar P. Rowell's syndrome: a rare but distinct entity in rheumatology. BMJ Case Rep 2020; 13:e235173. [PMID: 32967943 PMCID: PMC7513572 DOI: 10.1136/bcr-2020-235173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2020] [Indexed: 11/04/2022] Open
Abstract
Rowell's syndrome is a rare disorder characterised by an association of lupus erythematosus with erythema multiforme (EM)-like skin lesions. EM as the initial clinical presentation of systemic lupus erythematosus is also atypical and even rarer. We report the case of an 18-year-old girl admitted to our hospital with fever and polyarthralgia along with multiple discrete ill-defined target lesions with crust formation over forehead, cheek, external ears, scalp, upper chest and back (predominantly over sun-exposed areas) with ulceration over hard palate. Investigations revealed pancytopaenia, a positive rheumatoid factor, positive antinuclear antibody with a speckled pattern, anti-Smith antibody and strongly positive anti-Ro. Patient was diagnosed with Rowell's syndrome as per clinical and laboratory features. Majority of skin lesions including oral ulcerations subsided gradually after treatment with steroids and hydroxychloroquine.
Collapse
Affiliation(s)
- Atanu Chandra
- Internal Medicine, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Swarup Kanta Saha
- Internal Medicine, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Aritra Kumar Ray
- Internal Medicine, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | | |
Collapse
|
10
|
Aguirre-Martinez I, Vélez-Tirado N, García-Romero MT, Rodríguez-Lozano AL, Corcuera-Delgado CT, Yamazaki-Nakashimada M, Rivas-Larrauri F. Rowell syndrome complicated with macrophage activation syndrome in a child. Lupus 2019; 28:1716-1721. [PMID: 31674268 DOI: 10.1177/0961203319886030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Rowell syndrome (RS) is a rare disease characterized by the association of systemic lupus erythematosus (SLE) or cutaneous lupus with lesions similar to erythema multiforme and the presence of autoantibodies including ANA, SSA, SSB, or rheumatoid factor. Due to the low incidence of this disease, the epidemiology of RS is not clear. So far there are 95 cases reported in the literature; of these, only seven cases are pediatric patients. Macrophage activation syndrome (MAS) is an increasingly recognized complication of SLE, although its true prevalence in childhood is still unknown. We describe a unique pediatric patient with RS who developed MAS.
Collapse
Affiliation(s)
- I Aguirre-Martinez
- Dermatology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - N Vélez-Tirado
- Clinical Immunology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - M T García-Romero
- Dermatology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - A L Rodríguez-Lozano
- Clinical Immunology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | | | - F Rivas-Larrauri
- Clinical Immunology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| |
Collapse
|
11
|
Alkul S, Behrens E, Stetson C. Rowell syndrome with recurrence from photoexacerbation: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19847337. [PMID: 31065361 PMCID: PMC6487764 DOI: 10.1177/2050313x19847337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Rowell syndrome is a controversial entity composed of erythema multiforme-like lesions coexisting with lupus erythematosus. We describe a case of a 61-year-old male with a history of systemic lupus erythematosus who presented with photoexacerbated flaccid bullae and erosive plaques after repetitive sun exposure. Based on his clinical history, biopsy, and laboratory findings, he fulfilled diagnostic criteria for Rowell syndrome as described by Zeitouni et al. With oral prednisone, hydroxychloroquine, mycophenolate mofetil, and local wound care with petrolatum, the patient’s number of lesions decreased, as well as his pain and tenderness. He subsequently did not develop any new erosions. This case highlights the diagnostic criteria of this hybrid clinicopathological syndrome and its nature of photosensitivity.
Collapse
Affiliation(s)
- Suzanne Alkul
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Emily Behrens
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Cloyce Stetson
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| |
Collapse
|
12
|
A Young Woman With an Erythematous Rash, Fever, Tachycardia, and Pancytopenia: Answer. Am J Dermatopathol 2019; 41:73-74. [DOI: 10.1097/dad.0000000000000933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Abstract
We have explored the rash that appears as target lesions, with the central and dominant diseases belonging to the Stevens-Johnson syndrome/toxic epidermal necrolysis group. After presenting the clinical patterns of an individual target lesion and classifying them into different types of lesions, the contribution has been organized with groups characterized by such specific findings according to the type of lesion: flat or raised, typical or atypical, presence or absence of fever, presence or absence of mucosal ulcerations, presence or absence of arthralgias, and/or internal organ involvement. Other specific features, such as histologic appearance, immunofluorescence findings, and laboratory changes, are considered. We provide clinicians with an algorithmic, systematic, and logical approach to diagnose the condition of the patients who present with targetoid lesions, and enable them to differentiate between those with serious systemic and life-threatening diseases from others with ordinary skin ailments.
Collapse
Affiliation(s)
- Ronni Wolf
- The School of Medicine, Hebrew University, Jerusalem, Israel; Hadassah Medical Center, Jerusalem, Israel.
| | - Jennifer L Parish
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Lawrence Charles Parish
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
14
|
Brănișteanu DE, Ianoşi SL, Dimitriu A, Stoleriu G, Oanţǎ A, Brănișteanu DC. Drug-induced Rowell syndrome, a rare and difficult to manage disease: A case report. Exp Ther Med 2017; 15:785-788. [PMID: 29434682 PMCID: PMC5777104 DOI: 10.3892/etm.2017.5557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/05/2017] [Indexed: 12/19/2022] Open
Abstract
Rowell syndrome is defined as the association between lupus erythematosus, erythema multiforme-like lesions and characteristic immunological changes including positive tests for rheumatoid factor, speckled antinuclear antibody, positive anti-Ro or anti-La antibodies. The present report presents the case of a 45-year-old female patient who was previously diagnosed in January 2010 with terbinafine-induced subacute cutaneous lupus erythematosus and was admitted for a skin eruption consisting of erythematous-papular erythema multiforme-like lesions, primarily on the trunk and limbs. The associated symptoms consisted of fatigability, myalgia and gonalgia. In October 2015, the illness reoccurred ~1 week after the initiation of Helicobacter pylori eradication treatment. Anti-Ro antibodies, rheumatoid factor and antinuclear antibody tests were positive. Given the patient's medical history, clinical manifestations, and laboratory, histopathological and immunofluorescence microscopy findings, a diagnosis of Rowell syndrome was made. Systemic corticosteroids (methylprednisolone; 0.5 mg/kg/day) and immunomodulatory therapy (azathioprine; 50 mg/day) were administered with the associated medication (omeprazole, 20 mg/day; KCl, 1 g/day) and topical dermocorticoids (fluticasone propionate 0.05% cream; 1 application/day), with a favorable outcome. The major diagnostic criteria for Rowell syndrome are the presence of lupus erythematosus (acute, subacute or systemic), erythema multiforme-like lesions and positive testing for antinuclear antibodies. The minor diagnostic criteria for Rowell syndrome are chilblains, the presence of anti-Ro antibodies and positive testing for rheumatoid factor. A diagnosis of Rowell syndrome is made if the patient exhibits all major criteria and at least one minor criterion. The present case met all diagnostic criteria, excluding the presence of chilblains. Notably, in this case there was a co-occurrence of subacute lupus erythematosus and Rowell syndrome lesions, which was drug-induced.
Collapse
Affiliation(s)
- Daciana Elena Brănișteanu
- Department of Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 700715 Iași, Romania
| | - Simona Laura Ianoşi
- Department of Dermatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Andreea Dimitriu
- Department of Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 700715 Iași, Romania
| | - Gabriela Stoleriu
- Department of Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 700715 Iași, Romania
| | - Alexandru Oanţǎ
- Department of Dermatology, Transilvania University of Brașov, 500036 Brasov, Romania
| | | |
Collapse
|
15
|
Roujeau JC, Revuz J. Encore un « dernier mot » sur le syndrome de Rowell. Ann Dermatol Venereol 2017; 144:e1-e3. [DOI: 10.1016/j.annder.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
16
|
Roujeau JC, Revuz J. [Another 'last word' on Rowell's syndrome]. Ann Dermatol Venereol 2017; 144:247-249. [PMID: 28347405 DOI: 10.1016/j.annder.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
Affiliation(s)
- J-C Roujeau
- Université Paris Est Créteil (UPEC), 61, avenue du Général-de-Gaulle, 94000 Créteil, France
| | - J Revuz
- 11, chaussée de la Muette, 75016 Paris, France.
| |
Collapse
|
17
|
Schissler C, Banea S, Tortel MC, Mahé A. [A new case of Rowell's syndrome]. Ann Dermatol Venereol 2017; 144:263-267. [PMID: 28325515 DOI: 10.1016/j.annder.2017.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/05/2017] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This article introduces a new case of Rowell's syndrome, a controversial entity defined by the association of lupus erythematosus and erythema multiforme. OBSERVATION A 43-year-old woman was diagnosed with lupus erythematosus induced by esomeprazole. Because her eruption did not improve after withdrawal of the drug, hydroxychloroquine was administered. Two weeks later, the patient described new annular lesions on her chest and arms, both erosive and crusted, and some had a target-like appearance. The oral mucosa was also affected. Histology revealed sub-epidermal blistering with keratinocytic necrosis, strongly suggesting erythema multiforme. Screening for other causes of erythema multiforme proved negative. A positive outcome was achieved with corticosteroids and hydroxychloroquine. One year later, the patient was in complete remission for both lupus erythematosus and erythema multiforme. DISCUSSION The association of lupus erythematosus and erythema multiforme first described in 1963 is known as Rowell's syndrome. While diagnostic criteria have been established in the literature, the reality of this entity is still contested. The annular lesions of subacute lupus erythematosus may be confused with the lesions of erythema multiforme. As suggested in the above section, other authors consider Rowell's syndrome to be a singular entity. Indeed, our patient developed lesions distinct from those initially suggesting subacute lupus erythematosus, in particular: the target-like aspect of the elementary lesions, mucosal involvement, a distinct histological aspect, and dissociated outcomes. Ultimately, the definition of Rowell's syndrome remains highly debated.
Collapse
Affiliation(s)
- C Schissler
- Clinique dermatologique, faculté de médecine, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
| | - S Banea
- Service de dermatologie, hôpital Pasteur, 39, avenue de la Liberté, 68024 Colmar, France
| | - M-C Tortel
- Service d'anatomie pathologique, hôpital Pasteur, 39, avenue de la Liberté, 68024 Colmar, France
| | - A Mahé
- Service de dermatologie, hôpital Pasteur, 39, avenue de la Liberté, 68024 Colmar, France
| |
Collapse
|
18
|
LÚPUS ERITEMATOSO SISTÊMICO E ERITEMA MULTIFORME: RELATO DE CASO. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
19
|
Yu J, Brandling-Bennett H, Co DO, Nocton JJ, Stevens AM, Chiu YE. Toxic Epidermal Necrolysis-Like Cutaneous Lupus in Pediatric Patients: A Case Series and Review. Pediatrics 2016; 137:peds.2015-4497. [PMID: 27245834 DOI: 10.1542/peds.2015-4497] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2016] [Indexed: 11/24/2022] Open
Abstract
Bullous eruptions in patients with underlying systemic lupus erythematosus (LE) can mimic toxic-epidermal necrolysis (TEN), a rapidly progressive mucocutaneous reaction usually associated with medication use. Differentiating between classic drug-induced TEN and TEN-like cutaneous LE is important but difficult. We report a series of 3 patients with pediatric systemic LE who were admitted with severe worsening of skin disease resembling TEN. However, the initial photo-distribution of the eruption, subacute progression, limited mucosal involvement, mild systemic symptoms, supportive biopsy and laboratory results, and lack of culprit drugs was more suggestive of a TEN-like cutaneous LE. These patients recovered with various systemic immunosuppressive medications including methylprednisolone, intravenous immunoglobulin, and plasmapheresis. Our cases are rare and demonstrate key clinical and histologic features of TEN-like cutaneous LE in young patients and the importance of differentiating this entity from drug-induced TEN.
Collapse
Affiliation(s)
- JiaDe Yu
- Department of Dermatology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | - Dominic O Co
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Section of Rheumatology, Department of Pediatrics, and
| | - James J Nocton
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Section of Rheumatology, Department of Pediatrics, and
| | - Anne M Stevens
- Rheumatology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington; and Division of Rheumatology, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Yvonne E Chiu
- Division of Pediatric Dermatology, Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin;
| |
Collapse
|
20
|
López Caleya JF, Martín Rodrigo L, Gonzalvo Rodriguez P, Hidalgo García Y. Rowell's syndrome: The two sides of the truth. ACTA ACUST UNITED AC 2016; 12:354-355. [PMID: 26803724 DOI: 10.1016/j.reuma.2015.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
Affiliation(s)
| | - Laura Martín Rodrigo
- Servicio de Medicina Interna, Fundación Hospital de Jove, Gijón, Asturias, España
| | | | | |
Collapse
|
21
|
Abstract
Rowell syndrome is a rare disease consisting of erythema multiforme-like lesions associated with lupus erythematosus. The syndrome occurs mostly in middle-aged women. The authors describe the syndrome in a 15-year-old boy who responded well to systemic steroids and hydroxychloroquine.
Collapse
Affiliation(s)
- Ramesh Y Bhat
- Department of Paediatrics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Chaitanya Varma
- Department of Paediatrics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Sonia Bhatt
- Department of Paediatrics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - C Balachandran
- Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| |
Collapse
|
22
|
Yager JA. Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis: a comparative review. Vet Dermatol 2014; 25:406-e64. [PMID: 24990284 DOI: 10.1111/vde.12142] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Human erythema multiforme (EM) and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) are separate conditions. There is no consensus on classification criteria for the eponymous diseases in animals. RESULTS Animal EM is very different from 90% of human EM, which is herpes virus associated (HAEM). Animals lack acrally distributed, typical raised targets. Unlike canine parvovirus 'EM', HAEM is not an active infection. Animal EM is often attributed to drugs, but this is rarely proved. Conversely, human and animal SJS/TEN are almost identical, life-threatening disorders of epidermal necrosis and detachment, typically triggered by drugs (occasionally by infectious agents). Both EM and SJS/TEN are mediated by cytotoxic lymphocyte responses against altered keratinocytes (infectious agents or drugs). Apoptosis results from direct cytotoxicity or through soluble mediators, namely Fas ligand, granzymes, perforin and granulysin. Diagnosis in humans is clinicopathological, with emphasis on clinical lesions; histopathology confirms the pathological process as interface (cytotoxic) dermatitis. Human EM is self-limiting; only recurrent and rare persistent cases require antiviral/immunosuppressive therapies. Drug-induced EM responds to drug withdrawal. Idiopathic canine EM (>40%) is usually chronic, refractory to treatment and may represent heterogeneous conditions. Early identification and removal of the causative drug and high-quality supportive care are critical in SJS/TEN. Mortality rate is nevertheless high. CONCLUSIONS AND CLINICAL IMPORTANCE (1) Histopathological lesions do not reliably differentiate EM, SJS and TEN. (2) A multicentre study to develop a consensus set of clinical criteria for EM and SJS/TEN in animals is overdue. (3) No adjunctive therapies, including intravenous immunoglobulin and ciclosporin, have met evidence-based standards.
Collapse
Affiliation(s)
- Julie A Yager
- Department of Pathobiology, University of Guelph, Guelph, Ontario, Canada, N1G2W1
| |
Collapse
|
23
|
Rubio-González B, Angulo-Martínez L, Vanaclocha-Sebastián F, Postigo-Llorente C, Llamas-Martín R. Toxic epidermal necrolysis-like lesions as a manifestation of lupus erythematosus: the clinical picture of two cases. Arthritis Rheumatol 2014; 66:1607. [PMID: 24577870 DOI: 10.1002/art.38426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
24
|
Systemic Lupus Erythematosus Associated with Rowell's Syndrome: A Clinical Pathology Conference Held by the Division of Rheumatology at Hospital for Special Surgery. HSS J 2013; 9:289-92. [PMID: 24426883 PMCID: PMC3772164 DOI: 10.1007/s11420-013-9356-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 07/26/2013] [Indexed: 02/07/2023]
|
25
|
Bonciolini V, Antiga E, Caproni M, Fabbri P. Rowell syndrome: does it exist? Clin Exp Dermatol 2013; 39:58. [PMID: 23782168 DOI: 10.1111/ced.12183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2013] [Indexed: 11/28/2022]
Affiliation(s)
- V Bonciolini
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy.
| | | | | | | |
Collapse
|
26
|
Chandrashekar L. Update on cutaneous lupus erythematosus. Indian J Dermatol Venereol Leprol 2012; 78:129-32. [PMID: 22421640 DOI: 10.4103/0378-6323.93626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|