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Rechdan M, Svoboda S, Mojica R, Chung M, Motaparthi K, Saikaly SK. Acute vesiculobullous eruption in lupus patient on trimethoprim-sulfamethoxazole. JAAD Case Rep 2024; 50:126-128. [PMID: 39148639 PMCID: PMC11326511 DOI: 10.1016/j.jdcr.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024] Open
Affiliation(s)
| | - Steven Svoboda
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Rafael Mojica
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Michael Chung
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Sami K Saikaly
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
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2
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Manjaly P, Sanchez K, Gregoire S, Ly S, Kamal K, Mostaghimi A. Superficial and Bullous Neutrophilic Dermatoses: Sneddon-Wilkinson, IgA Pemphigus, and Bullous Lupus. Dermatol Clin 2024; 42:307-315. [PMID: 38423689 DOI: 10.1016/j.det.2023.08.010] [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: 03/02/2024]
Abstract
Sneddon-Wilkinson disease (SWD), IgA pemphigus, and bullous systemic lupus erythematosus (BSLE) are superficial and bullous neutrophilic dermatoses. They are all characterized by sterile neutrophilic infiltrate but differ in the level of skin affected and presence of autoantibodies. Both SWD and IgA pemphigus present with grouped flaccid pustules and have epidermal involvement; it is unclear whether they are distinct or exist on a spectrum of the same disease. IgA pemphigus is distinguished from SWD by positive direct immunofluorescence showing intercellular IgA deposition. BSLE presents with tense bullae, dermal neutrophilic infiltrate, and direct immunofluorescence showing linear IgG deposition along the dermal-epidermal junction.
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Affiliation(s)
- Priya Manjaly
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA; Boston University School of Medicine, Boston, MA 02118, USA
| | - Katherine Sanchez
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Samantha Gregoire
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Sophia Ly
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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3
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Jangid SD, Madke B, Singh A, Bhatt DM, Khan A. A Case Report on Senear-Usher Syndrome. Cureus 2023; 15:e49268. [PMID: 38957191 PMCID: PMC11218602 DOI: 10.7759/cureus.49268] [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: 10/24/2023] [Accepted: 11/22/2023] [Indexed: 07/04/2024] Open
Abstract
Pemphigus erythematosus is an uncommon autoimmune bullous skin disorder with clinical, histological, and serological characteristics that overlap with lupus erythematosus and pemphigus foliaceus. The autoantigens are desmoglein 3, desmoglein 1, and desmosomal adhesion proteins in keratinocytes. When these bonds are disrupted, it causes acantholysis of keratinocytes, leading to the fluid collection between layers. Hence, the patient will present clinically with small flaccid bullae with crusting and scaling, mainly on the seborrheic areas. We report the case of a 21-year-old female presenting to us with multiple hyperkeratotic plaques, mainly on the seborrheic areas, including the face, chest, and elbows. The patient was evaluated further, and based on clinical and laboratory investigations, the diagnosis of pemphigus erythematosus associated with anti-double-stranded deoxyribonucleic acid (anti-dSDNA) and anti-nuclear antibody (ANA) positivity was made. The patient was then managed using immunosuppressant therapy, and the entire course has been detailed in this case report.
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Affiliation(s)
- Shivani D Jangid
- Dermatology, Venereology, and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhushan Madke
- Dermatology, Venereology, and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Adarshlata Singh
- Dermatology, Venereology, and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Drishti M Bhatt
- Dermatology, Venereology, and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arshiya Khan
- Dermatology, Venereology, and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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4
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Ratanapokasatit Y, Seree-Aphinan C, Chanprapaph K. Refractory Bullous Systemic Lupus Erythematosus Successfully Treated with Rituximab: A Case Report and Literature Review. Clin Cosmet Investig Dermatol 2023; 16:883-890. [PMID: 37038449 PMCID: PMC10082637 DOI: 10.2147/ccid.s403866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/25/2023] [Indexed: 04/07/2023]
Abstract
Bullous systemic lupus erythematosus (BSLE) is a rare blistering skin manifestation of systemic lupus erythematosus (SLE). Dapsone is reported to be helpful in mild-to-moderate BSLE cases; however, its use may be limited or prohibited due to particular complications such as drug hypersensitivity, dose-dependent hemolytic anemia, and other significant hematologic abnormalities. Rituximab, an anti-CD20 monoclonal antibody, has been reported with off-label use in BSLE patients, but data are still limited. Hence, our objective is to explore the efficacy of rituximab among these patients. Herein, we report a 21-year-old Thai woman presented with blistering eruption on the oral cavity, scalp, trunk, and extremities for 1 month. The investigations revealed a positive direct Coomb's test, an elevated erythrocyte sedimentation rate (ESR), and a positive antinuclear antibody (ANA). Skin biopsy showed focal interface dermatitis. Direct immunofluorescence (DIF) illustrated mixed linear and granular deposition of immunoglobulin (Ig)G, IgM, IgA, and C3 along the dermo-epidermal junction (DEJ). Enzyme-linked immunosorbent assay (ELISA) showed circulating antibodies to type VII collagen. She was diagnosed with severe BSLE and autoimmune hemolytic anemia (AIHA) refractory to several oral immunosuppressants but was successfully treated with rituximab. The authors also performed a review of the literature on prior BSLE cases managed with rituximab.
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Affiliation(s)
- Yanisa Ratanapokasatit
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chutima Seree-Aphinan
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Kumutnart Chanprapaph, Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand, Tel +662-201-1141, Fax +662-201-1211, Email
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5
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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.
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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
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6
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Keshavamurthy C, Fibeger E, Virata A, Bansal P. Successful treatment of bullous lupus with corticosteroids and belimumab: A case report. Mod Rheumatol Case Rep 2023; 7:52-56. [PMID: 35538618 DOI: 10.1093/mrcr/rxac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/20/2022] [Accepted: 04/23/2022] [Indexed: 01/07/2023]
Abstract
Cutaneous lupus erythematosus (CLE) is one of the most common manifestations of systemic lupus erythematosus (SLE), although it can manifest as an independent entity as well. Bullous systemic lupus erythematosus (BSLE) is a rare cutaneous manifestation of SLE presenting as tense vesiculobullous eruptions in a photosensitive distribution. Pathophysiology is secondary to autoantibodies against noncollagenous domain 1 and 2 (NC1 and NC2) type VII collagen, and histopathology reveals dense neutrophilic infiltration of the dermis with direct immunofluorescence showing IgG deposition at dermoepidermal junction. There is lack of data on available therapeutic options to treat BSLE, and varying responses to dapsone, methotrexate, azathioprine and corticosteroids have been reported. Belimumab, a fully humanised Change to Immunoglobulin G1λ (IgG1λ) monoclonal antibody targeting soluble B lymphocyte stimulator protein, was the first Food and Drug Administration-approved drug for SLE and has been reported to be effective for CLE. We present the case of a 41-year-old black female with SLE presenting with BSLE, who was successfully treated with corticosteroids and belimumab and did not experience disease relapse even after discontinuation of corticosteroids. To our knowledge, this is the first reported case of successful treatment of BSLE with belimumab, and further research can help determine the role of belimumab in the treatment of BSLE.
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Affiliation(s)
| | - Emily Fibeger
- Department of Dermatology, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Andrew Virata
- Department of Dermatopathology, Tareen Dermatology, Roseville, MN, USA
| | - Pankaj Bansal
- Department of Rheumatology, Mayo Clinic Health System, Eau Claire, WI, USA
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7
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Saowaluksakul W, Seree-aphinan C, Rutnin S, Boonyawat K, Chanprapaph K. Coexistence of Discoid Lupus Erythematosus and Paraneoplastic Pemphigus: A Case Report and Literature Review. Clin Cosmet Investig Dermatol 2022; 15:2477-2486. [DOI: 10.2147/ccid.s389341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
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8
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[Translated article] Extensive Skin Detachment in an Older Man. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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9
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A Rare Manifestation of Bullous Systemic Lupus Erythematosus in Children: A 10-year Retrospective Study in a Tertiary Care Hospital. Autoimmune Dis 2022; 2022:9388745. [PMID: 35911475 PMCID: PMC9325629 DOI: 10.1155/2022/9388745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022] Open
Abstract
Bullous systemic lupus erythematosus (BSLE) is an uncommon cutaneous presentation that occurs even less frequent in the pediatric population. A retrospective review was performed from January 2012 to December 2021 in all pediatric patients (aged <18 years) who fulfilled the diagnostic criteria for BSLE to evaluate the clinical characteristics, extracutaneous involvement, histopathologic features, immunofluorescence patterns, serological abnormalities, internal organ involvement, treatments, and outcomes. Among 1,415 patients with SLE, five patients were validated for the diagnosis of BSLE, accounting for 0.35%. The mean age at diagnosis was 12.2 years (standard deviation, 1.92). The clinical features of BSLE in the study population were generalized tense bullae and large extensive vesicles on the lips and perioral and mucosal areas. Pediatric BSLE in the study population revealed high SLE disease activity with multiple organ involvement. Hematologic abnormalities, serositis, and renal involvement were found in all patients, while polyarthritis (40%) and neurological abnormalities (40%) were less frequently observed. Systemic corticosteroids, intravenous immunoglobulin, immunosuppressants, antimalarials, and dapsone were prescribed in the study population. The cutaneous lesions subsided in all patients with a median clearance duration of 14 days (range, 5–56 days). BSLE in the pediatric population has auxiliary manifestations with high disease activity. Multiple organ involvement, especially hematologic abnormalities, serositis, and renal involvement, was frequently found in the study population. Although cutaneous lesions in BSLE subsided in all patients, involvement of other organs, especially renal impairment, required aggressive treatment, and long-term follow-up.
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10
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Michalska-Jakubus M, Wdowiak-Filip A, Kowalewski C, Woźniak K, Krasowska D. Localized Blistering Eruption of the Face and Neck - A Case Study and Differential Considerations. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:271-281. [PMID: 35221704 PMCID: PMC8865756 DOI: 10.2147/ccid.s350743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022]
Abstract
We describe a 36-year-old woman with erythematous lesions and well-tense blisters confined to the face and neck of two months history, without mucosal involvement and no triggering factors. A lesional skin biopsy showed a subepidermal blister. Direct immunofluorescence of peribullous skin identified linear deposits of IgG, IgA, and C3 complement along the basement membrane zone, whereas indirect immunofluorescence was negative. Using fluorescence overlay antigen mapping by laser scanning confocal microscopy, linear immunoglobulins deposits were found to be located above collagen IV and below laminin 332 (formerly named laminin 5), in a pattern typical of mucous membrane pemphigoid (formerly named cicatricial pemphigoid). Consequently, in terms of the clinical picture and confocal study, a rare variant of mucous membrane pemphigoid was established, namely Brunsting-Perry type. Combined therapy with oral prednisone and dapsone healed the lesions, leaving atrophic scars and milia. The paper also provides a review of previous reports on this item as well as a comprehensive differential diagnosis of facial blistering lesions.
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Affiliation(s)
| | - Anita Wdowiak-Filip
- Department of Cosmetology and Aesthetic Medicine, Medical University of Lublin, Lublin, Poland
| | - Cezary Kowalewski
- Department of Dermatology, Immunodermatology and Venereology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Woźniak
- Department of Dermatology, Immunodermatology and Venereology, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Krasowska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
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11
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Camacho García D, Vallés Blanco L, Santonja Garriga C. Exfoliación cutánea extensa en paciente de edad avanzada. ACTAS DERMO-SIFILIOGRAFICAS 2021; 113:895-896. [DOI: 10.1016/j.ad.2020.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022] Open
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12
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Tanaka A, Bun S. Stevens‐Johnson syndrome/toxic epidermal necrolysis‐like acute cutaneous lupus erythematosus in a patient with systemic lupus erythematosus. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2021. [DOI: 10.1002/cia2.12207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Aya Tanaka
- Department of Dermatology Sakai City Medical Center Sakai‐shi Japan
| | - Shota Bun
- Department of Dermatology Sakai City Medical Center Sakai‐shi Japan
- Department of Dermatology National Hospital Organization Osaka National Hospital Osaka‐shi Japan
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13
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Rakita U, Grushchak S, Guo L, Braniecki M, Mehta S. Atypical Subacute Cutaneous Lupus in a Patient on Apixaban Anticoagulation Therapy: A Case Report and Review of the Literature. Cureus 2021; 13:e16571. [PMID: 34434672 PMCID: PMC8380169 DOI: 10.7759/cureus.16571] [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] [Accepted: 07/05/2021] [Indexed: 11/26/2022] Open
Abstract
Subacute cutaneous lupus erythematosus (SCLE) is a rare cutaneous lupus erythematosus (CLE) subtype manifesting in middle-aged Caucasians with photo-distributed papulosquamous or annular lesions. Drug-induced SCLE (DI-SCLE) forms present in a similar manner but direct oral anticoagulants are rarely implicated. We report an unusual case of SCLE in a 37-year-old African American patient with a history of unprovoked deep vein thromboses (DVT) who presented with new-onset photoprotected polymorphic lesions two months after the initiation of apixaban anticoagulation therapy. Our case demonstrates the heterogeneous nature of SCLE presentation and highlights the possibility of apixaban as a potential causative agent of DI-SCLE in immunogenetically susceptible individuals. Moreover, we hypothesize on the etiopathogenesis of our patient’s atypical presentation.
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Affiliation(s)
- Uros Rakita
- Dermatology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | - Solomiya Grushchak
- Department of Dermatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Lily Guo
- Dermatology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | - Marylee Braniecki
- Department of Dermatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Shilpa Mehta
- Department of Dermatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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14
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Lu Z, Su D, Li X, Da Z. LABD-like manifestation in a patient with systemic lupus erythematosus. Rheumatology (Oxford) 2021; 60:e192-e194. [PMID: 33367787 DOI: 10.1093/rheumatology/keaa826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zhimin Lu
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, People's Republic of China.,Department of Immunology, College of Basic Medical Science, Dalian Medical University, Dalian, People's Republic of China
| | - Dinglei Su
- Department of Rheumatology and Immunology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xia Li
- Department of Immunology, College of Basic Medical Science, Dalian Medical University, Dalian, People's Republic of China
| | - Zhanyun Da
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, People's Republic of China
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15
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Ahmed Eltahir NI, Elgenaid SN, Adam Essa ME, Ahmed AA, Sati Mohamed AS, Ali Hussein MM, Abubaker A, Mohamed Elsayed E, Mohammed Ibrahim SE, Mohamed Ibrahim O, Mohammed Elagib E. Recurrent Stevens-Johnson syndrome in a patient with systemic lupus erythematosus: a case report. J Int Med Res 2021; 48:300060520964348. [PMID: 33086898 PMCID: PMC7585900 DOI: 10.1177/0300060520964348] [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] [Indexed: 11/17/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a systemic disease that affects many organs. A few patients with SLE develop Stevens–Johnson syndrome (SJS), a life-threatening disease characterized by the appearance of a partial-thickness burn in the skin and mucous membranes. This report aims to increase awareness among clinicians about the relationship between SLE and SJS. An 18-year-old man was admitted to the rheumatology department of Omdurman Military Hospital with a skin rash that was preceded by symptoms of a short febrile illness. He had a maculopapular rash on his palms, soles, trunk, and mucous membranes. The patient had been diagnosed with SLE at 10 years of age and had had SJS three times since the diagnosis of SLE. Investigations to exclude other diagnoses were conducted, and a skin biopsy showed features consistent with early SJS. The patient received intravenous hydrocortisone, oral prednisolone, and oral acyclovir. The lesions resolved 3 weeks after treatment with acyclovir and he was discharged in good condition. A young patient with SLE and recurrent SJS with no immunodeficiency responded very well to the conventional SJS therapy after 3 weeks of treatment.
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Affiliation(s)
| | | | - Mohammed Elmujtba Adam Essa
- Departments of Clinical Medicine, Medical and Cancer Research Institute (MCRI), Nyala, Sudan.,Faculty of Medicine, Al Fashir University, Al Fashir, Sudan.,Surgery Research Department, Sudanese Medical Research Association, Khartoum, Sudan
| | - Abdelkareem A Ahmed
- Departments of Clinical Medicine, Medical and Cancer Research Institute (MCRI), Nyala, Sudan.,Department of Physiology and Biochemistry, Faculty of Veterinary Science, University of Nyala, Nyala, Sudan.,Biomedical Research Institute, Darfur University College, Nyala, Sudan.,Institute of Molecular Biology, University of Nyala, Nyala, Sudan
| | - Ayman Sati Sati Mohamed
- Departments of Clinical Medicine, Medical and Cancer Research Institute (MCRI), Nyala, Sudan.,Faculty of Medicine, Al Fashir University, Al Fashir, Sudan
| | - Mustafa Mohammed Ali Hussein
- Departments of Clinical Medicine, Medical and Cancer Research Institute (MCRI), Nyala, Sudan.,Faculty of Medicine, Al Fashir University, Al Fashir, Sudan
| | - Azza Abubaker
- Faculty of Medicine, Omdurman Islamic University, Khartoum, Sudan
| | - Elnazir Mohamed Elsayed
- Faculty of Medicine, Department of Histopathology, Russian Military Medical Academy, Saint Petersburg, Russia
| | | | - Osman Mohamed Ibrahim
- Department of Dermatology and Venereal Diseases, Omdurman Military Hospital, Khartoum, Sudan
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16
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Hobbs LK, Noland MMB, Raghavan SS, Gru AA. Pemphigus erythematosus: A case series from a tertiary academic center and literature review. J Cutan Pathol 2021; 48:1038-1050. [PMID: 33609053 DOI: 10.1111/cup.13992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/18/2021] [Accepted: 02/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pemphigus erythematosus (PE) is a rare autoimmune skin condition with clinical, histopathological, and serological features that show overlap between lupus erythematosus and pemphigus foliaceus. It typically presents with erythematous, scaly plaques and has a female predominance. METHODS After Institutional Review Board (IRB) approval, we searched the internal pathology database for "pemphigus erythematosus" in the diagnostic line between 1 January 2000 and 30 July 2020. A comprehensive chart review was performed to collect patient demographics, clinical presentation, and treatment course. We performed a review of the literature and clinical, histopathological, and serological features were collected for comparison to our case series. RESULTS Five patients in the case series and 87 patients in the literature were diagnosed with PE. Clinical, histopathological, and serological features were consistent with what has been reported in the literature, although our cohort demonstrated a younger age at presentation, along with a higher proportion (80%) of Black patients. Of the 25 patients in the literature whose race was reported, only five patients (20%) were reported to be Black. CONCLUSION This is the first case series of PE that has shown an increased prevalence among middle-aged Black patients. No specific trend in regards to race was seen in the review of the literature.
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Affiliation(s)
- Landon K Hobbs
- Department of Dermatology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Mary-Margaret B Noland
- Department of Dermatology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Shyam S Raghavan
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Alejandro A Gru
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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17
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Vishwajeet V, Chatterjee D, Saikia UN, Mahajan R, Radotra B, Handa S, De D. Bullous lesions in patients with cutaneous lupus erythematosus: A clinicopathologic study. J Am Acad Dermatol 2021; 85:1641-1643. [PMID: 33421476 DOI: 10.1016/j.jaad.2020.12.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 12/19/2020] [Accepted: 12/25/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Vikarn Vishwajeet
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Uma Nahar Saikia
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rahul Mahajan
- Department of Dermatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bishan Radotra
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Dipankar De
- Department of Dermatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Lu J, Dong L, Zhang L, Zhang H, Wang L, Zhang J, Wan C. Toxic epidermal necrolysis after therapeutic plasma exchange in pediatric lupus patients and associated risk factors analysis. Lupus 2021; 30:465-472. [PMID: 33413003 DOI: 10.1177/0961203320981128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) is an effective means of treating systemic lupus erythematosus in children and is safe for most pediatric patients with systemic lupus erythematosus, but severe complications such as toxic epidermal necrolysis (TEN) may occur, which is a life-threatening condition. METHODS In this study, three systemic lupus erythematosus (SLE) children developed toxic epidermal necrolysis after TPE. We analyzed their medical history, clinical manifestations, SLEDAI scores, and immunological characteristics, compared to 117 cases of SLE patients without TEN after TPE, trying to find the possible risk factors. RESULTS The three children with TEN after plasma exchange appeared to have a higher proportion of male (male: female = 2:1), fever (100% Vs 32.5%), erythema on the cheek (100% Vs 54.7%), itching rash (100% Vs 54.7%), ruptured rash (100% Vs 54.7%), oral ulcer (100% Vs 54.7%) and higher LDH level (1826.0 ± 1113.1 Vs 721.1 ± 799.5 U/L), but lower white blood cell count (5.5 ± 3.3 Vs 7.2 ± 4.2 × 109/L), neutrophil count (4.7 ± 3.7 Vs 5.2 ± 3.6 × 109/L), lymphocyte count (0.6 ± 0.5 Vs 1.5 ± 0.8 × 109/L), platelet count (133.7 ± 58.1 Vs 178.5 ± 103.1 × 109/L) and C-reactive protein (all normal Vs 47.9% elevated). Autoantibody spectrum revealed that positive anti-SSA seemed more common (100% Vs 42.7%) in the three children. Relative risk analysis revealed that male (OR 21.4, 95%CI 1.78-257.186), ruptured skin rash (OR 56.5, 95%CI 4.199-760.196) and rash with itching (OR 24, 95%CI 1.98-290.896) are the risk factors of SLE patients developing TEN after plasma exchange. CONCLUSIONS We should pay particular attention to TEN after plasma exchange in SLE patients (3/120, 2.5%). This condition may be related to male, ruptured skin rash and rash with itching. For SLE patients with risk factors. We should arrange plasmapheresis more carefully.
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Affiliation(s)
- Jing Lu
- Department of pediatric nephrology, West China Second Hospital of Sichuan University, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Sichuan, China
| | - Liqun Dong
- Department of pediatric nephrology, West China Second Hospital of Sichuan University, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Sichuan, China
| | - Lijuan Zhang
- Department of pediatric nephrology, West China Second Hospital of Sichuan University, Sichuan, China
| | - Hui Zhang
- Department of pediatric nephrology, West China Second Hospital of Sichuan University, Sichuan, China
| | - Lin Wang
- Dermatology Department, West China Hospital of Sichuan University, Sichuan, China
| | - Junqing Zhang
- The Third Affiliated Hospital of Zhengzhou University, Maternal and Child Health Hospital of Henan Province, Henan, China
| | - Chaomin Wan
- Department of pediatric nephrology, West China Second Hospital of Sichuan University, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Sichuan, China
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Bullous Lupus: An Atypical Case of Refractory Disease in a Patient with Sulfa Allergy. Case Rep Rheumatol 2020; 2020:8873337. [PMID: 32802547 PMCID: PMC7403923 DOI: 10.1155/2020/8873337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022] Open
Abstract
Bullous systemic lupus erythematosus (BSLE) is a rare cutaneous autoimmune disorder characterized by rapid, widespread vesiculobullous lesions in patients with Systemic Lupus Erythematosus (SLE). BSLE can present as the initial manifestation of SLE and may be a marker of severe disease. In this case report, we present a case of a 22-year-old African American woman with BSLE and impaired renal function with subsequent nephrotic range proteinuria concerning for lupus nephritis and autoimmune hemolytic anemia, refractory to systemic corticosteroids, immunoglobulin, and mycophenolate mofetil, requiring dapsone after careful desensitization due to prior history of angioedema with sulfa drugs. This case highlights the importance of the prompt recognition of BSLE as the initial manifestations of SLE and illustrates the association of BSLE with severe disease and the benefit of concomitant use of dapsone with corticosteroids and other immunosuppressant drugs, even in patients with a history of sulfa allergy.
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Zargham H, Ghazal S, Watters K, Nguyen KH. A case of toxic epidermal necrosis-like cutaneous eruption as the first manifestation and clue to the diagnosis of systemic lupus erythematosus: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20940420. [PMID: 32728443 PMCID: PMC7364792 DOI: 10.1177/2050313x20940420] [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: 05/11/2020] [Accepted: 06/05/2020] [Indexed: 11/20/2022] Open
Abstract
We present a rare case of a 61-year-old woman presenting with a widespread erosive eruption on her torso and extremities. Although the lesions were histologically compatible with toxic epidermal necrolysis, clinically the patient was hemodynamically stable, had no mucosal involvement and had no relevant medical history or potentially incriminating medications. Further investigations uncovered a new diagnosis of systemic lupus erythematosus, with this toxic epidermal necrolysis-like eruption being the first presentation of the disease. This case highlights the importance of broadening the differential diagnosis in patients presenting with acute widespread cleavage of the epidermis, using the spectrum of acute syndrome of apoptotic pan-epidermolysis as a reference.
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Affiliation(s)
- Hanieh Zargham
- Division of Dermatology, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
| | | | - Kevin Watters
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Khue Huu Nguyen
- Division of Dermatology, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
- Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
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