Drug induced lupus dil refers to an idiosyncratic side effect of numerous, apparently unrelated, medications, in which symptoms overlap with those of systemic lupus erythematosus. We report a case with typical clinical features of drug induced lupus erythematosus, together with verrucous endocarditis and pleuropericardial effusion, due to amiodarone treatment. Drug induced sle has been diagnosed as a result of a combination of clinical and biologic signs. While symptoms can be severe, dil, unlike systemic lupus erythematosus sle, is fully reversible simply by discontinuation of the inducing medication, although full recovery can take several months. Dil is reversible by discontinuation of the medication. Sep 17, 2008 drug induced lupus erythematosus dile is defined as a lupuslike syndrome temporally related to continuous drug exposure which resolves after discontinuation of the offending drug. As lupus has become a paradigm for the study of autoimmune disease, immunologists investigating autoimmunity are becoming more interested in lupus. Drug induced lupus which has resolved is not rated. Drug induced lupus erythematosus dile is a variant of lupus erythematosus that resolves within days to months after withdrawal of the culprit drug in a patient with no underlying immune system dysfunction. The mechanism or mechanisms involved in drug induced lupus remain uncertain. The phenothiazines are known to be oxidized to free radical interme. The symptoms of drug induced lupus are similar to those of systemic lupus, but only rarely will any major organs be affected. The drugs most commonly connected with druginduced lupus are hydralazine.
Medications such as hydralazine, procainamide, methyldopa, chlorpromazine, quinidine, and minocycline are known to cause sle. Drug induced lupus erythematosus is similar but not identical to systemic lupus erythematosus sle. You may also develop drug induced lupus after taking sunsensitizing tetracycline drugs, sulfa drugs, antiseizure medications, or alpha inhibitors. The drugs most commonly connected with drug induced lupus are hydralazine used. Clinical features of patients with drug induced, rossapositive cutaneous lupus erythematosus cle. Druginduced lupus erythematosus is similar but not identical to systemic lupus erythematosus sle. Some lids induce a condition more akin to subacute cutaneous lupus erythematosus scle consequently, unless stated otherwise, reference to dil in this chapter means the term to encompass druginduced sle, scle and ccle chronic cutaneous lupus erythematosus.
We report two cases of patients with rheumatoid arthritis ra who developed symptoms and signs of sle and suggest that increasing use of these two agents as combination therapy in ra may cause an additive risk to the occurrence of this complication. Systemic lupus erythematosus sle is a chronic, multisystem, autoimmune disease characterized by periods of increased disease activity caused by inflammation of blood vessels and connective tissue. Druginduced lupus erythematosus associated with donepezil. I never had any side effects from this drug before,but god help me if i have to go off it. Development of drug induced systemic lupus erythematosus sle is an uncommon complication of the use of dpenicillamine and sulphasalazine. Manual of paper electrophoresis systems, model r, the beckman. Lupus is an autoimmune condition caused by a combination of factors, both genetic and environmental. It has been estimated that up to 10% of sle cases are drug induced. These drugs cause an autoimmune response the body attacks its own cells producing symptoms similar to those of sle. Certain clinical and laboratory features may distinguish these. Drug induced lupus erythematosus is an uncommon, mild to moderately severe, a lupuslike syndrome related in time to continuous exposure to a specific medication and which resolves after the trigger drug is ceased. Drug induced lupus is similar to sle, but occurs as the result of an overreaction to certain medications. The condition is much more than a positive antinuclear antibody ana.
To get an idea of how a client with a history of systemic lupus erythematosus sle would be viewed in the underwriting process, feel free to use the ask rx pert underwriter on the attached page for an informal quote. The present report concerns a patient who developed a systemic lupuslike. Drug induced sle can be ruled out if the ana is negative. Rheumatologists sometimes use specific criteria cdc pdf pdf 510kb external to classify sle for research purposes. Setting immunodermatology division of johns hopkins hospital baltimore, md. Oct 29, 2019 in this study, we aimed to measure the main differences in drug induced gene expression signatures across sle patients and to evaluate the potential for clinical data to build a machine learning. After cessation of amiodarone treatment, the patient recovered completely.
Dile or dil can occur as a sideeffect of certain medications. Lupus is not like or related to hiv human immune deficiency virus or aids. Their efficacy may not have been scientifically tested to the same degree as the drugs listed in the table above. The etiological mechanism underlying dil is linked to the inherent susceptibility of the adaptive immune system to lapse into auto. Druginduced lupus is probably mediated by reactive drug. Autoantibodies to myeloperoxidase in idiopathic and drug induced systemic lupus erythematosus and vasculitis. Systemic lupus erythematosus sle, is the most common type of lupus.
A 48 year old female presented to the hospital with new onset malar rash, arthralgias and other systemic symptoms after being started on sertraline for management of her depressive symptoms. Increased type i ifn in sle sera increased ifninduced genes in sle patients several sle risk gene variants in loci linked to type i ifn system slelike syndrome with ifna treatment hagberg n. Druginduced lupus erythematosus with emphasis on skin. Related conditions are drug induced cutaneous lupus and drug induced anca vasculitis. This means your body attacks healthy tissue by mistake. Before making a diagnosis of systemic lupus erythematosus sle, ruling out drugs as the cause of the condition is important. Although ethosuximide is less often prescribed, it is a potential cause of sle.
While drug induced lupus is not a major clinical problem because it can be fully cured by discontinuing use of the medication, it is of mechanistic interest that a low molecular weight xenobiotic. Druginduced lupus erythematosus by amiodarone rheumatology. Druginduced lupus dil is an autoimmune phenomenon where a drug. What was interesting was that the words autoimmune and drug induced lupus werent even in the documentation. Combination therapy for rheumatoid arthritis and druginduced. There is no evidence that people who develop ana without symptoms are at increased risk for developing drug induced lupus in the future. Because ethosuximide was rechallenged with recurrence of sle at age 24, there is a definite association between the drug and the development of the disease. Jul 10, 2018 drug induced lupus erythematosus dile is a variant of lupus erythematosus that resolves within days to months after withdrawal of the culprit drug in a patient with no underlying immune system dysfunction. Antihistone antibodies are commonly found in drug induced lupus but are also seen in sle and, therefore, cannot distinguish between the two. The slow acetylator phenotype clearly increases the risk of hydralazine induced ana positivity and druginduced lupus but is less important in procainamide and isoniazidassociated druginduced lupus and does not appear to influence the risk of druginduced lupus owing to other drugs or idiopathic sle. Druginduced lupus erythematosus is an uncommon, mild to moderately severe, a lupuslike syndrome related in time to continuous exposure to a specific medication and which resolves after the trigger drug is ceased. On antitumor necrosis factorinduced systemic lupus. Inherited differences in drug metabolism eg, acetylator status and immunogenetic characteristics are genetic factors that may influence the risk of developing disease.
Drug induced lupus dil is a side effect of longterm treatment with various medications, an idiosyncratic adverse drug reaction adr that has been documented for some seven decades. How is druginduced lupus erythematosus differentiated from. Drug induced lupus erythematosus dil or dile is an autoimmune disorder similar to systemic lupus erythematosus sle caused by chronic use of certain drugs. Acute interstitial nephritis and druginduced systemic lupus. Drug induced lupus erythematosus is a generally reversible condition that usually occurs in people being treated for a longterm illness. Systemic lupus erythematosus sle is a prevalent autoimmune disorder. Learn about systemic lupus erythematosus sle, the most common type of lupus.
Joint inflammation and pain, skin rash, pleurisy, and fever are the most common manifestations. Updating the american college of rheumatology revised criteria for the classification of systemic lupus erythematosus. It should be appreciated that criteria for reaching a diagnosis of drug induced lupuslike disease are not as rigorous as those for diagnosis of sle. Although the signs and symptoms of druginduced lupus overlap with those of idiopathic. Pediatric systemic lupus erythematosus american academy. Surgery caused autoimmune disease or drug induced lupus. The occurrence of malar rash, discoid lesions, alopecia, and oral ulcers is lower in traditional drug induced sle compared with idiopathic sle. Exposure to certain drugs may induce a lupuslike illness or exacerbate sle.
Causes of lupus or systemic lupus erythematosus sle. Druginduced lupus erythematosus statpearls ncbi bookshelf. Drug induced lupus erythematosus dile is an autoimmune variant of systemic lupus erythematosus triggered by the acute or chronic use of a medication. Acute interstitial nephritis and drug induced systemic lupus erythematosus due to chlorthalidone and amiodarone. Sle is regarded as a prototype disease due to the significant overlap in its symptoms with other autoimmune diseases. The occurrence of systemic lupus erythematosus sle as a result of pharmacological treatments is a condition named drug related lupus drl or drug induced lupus erythematosus dile. A newbie asking about drug induced lupus and zoloft. Stress, exhaustion, smoking or sun exposure can trigger lupus. While the recent and numerous television advertisements for the antitumor necrosis factor tnf agents. Over 6,000 healthcare professionals follow the blog, why arent you.
Druginduced subacute cutaneous lupus erythematosus discle is a dile variant with predominant skin involvement, temporally related to drug. Druginduced lupus and systemic lupus erythematosus. Such anas are directed toward deoxyribonucleoproteins i. When a patient presents with features suggestive of sle, the presence of anti nuclear antibodies ana in the patients serum is usually used as a screening test. Drug induced lupus is also called druginduced lupus erythematosus dile what is drug induced lupus.
Dile can arise months to years after exposure to drugs prescribed to treat various medical conditions eg, antihypertensives, antibiotic. A, the index patient shows scaly, annular, subacute cletype lesions on the lateral aspect of the right arm. Druginduced lupus erythematosus dile refers to a condition whose clinical. It was lampooned in a more recent sitcom as a magic elixir capable of transforming a friendless geek into the most popular kid at school.
To report the occurrence of drug induced systemic lupus erythematosus sle with multisystem manifestations in a patient who was initiated on treatment with sertraline. However, various theories have been developed regarding the pathogenesis of drug induced lupus. Druginduced lupus erythematosus dile is a variant of lupus erythematosus that resolves within days to months after withdrawal of the culprit drug in a patient with no underlying immune system dysfunction. With drug induced, symptoms will resolve after stopping medications. Systemic lupus erythematosus, fourth edition, provides an understanding of the basic mechanisms as well as the diagnostic and therapeutic aspects of lupus. Drug induced lupus is a lupuslike disease caused by certain prescription drugs. Drug induced lupus and sle sle is distinct from drug induced lupus, since dil generally has milder symptoms than sle, and no. List of systemic lupus erythematosus medications 41. This disorder has been described for the first time in 1945 by hoffman. Ain is an unexpected finding in dile but pointed to a drug induced process rather than classical sle. Mar 01, 2020 we report a rare case of a syndrome typical of drug induced lupus without the usual triggers. Over the years, multiple other agents have been linked to immunemediated glomerular disease, often with associated autoantibody formation. Druginduced systemic lupus erythematosus definition of. Systemic lupus erythematosus sle is the prototypic multisystem autoimmune.
Does sulphasalazine cause drug induced systemic lupus. Drug induced autoimmune disease was initially described decades ago, with reports of vasculitis and a lupuslike syndrome in patients taking hydralazine, procainamide, and sulfadiazine. Sle is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. Similarly to idiopathic lupus erythematosus, dile can be divided into systemic sle, subacute cutaneous scle and chronic cutaneous lupus ccle. A case report umut selamet1, ramy m hanna1,2, anthony sisk3, lama abdelnour1, lena ghobry4 and ira kurtz1,5 abstract drug induced lupus erythematosus has features distinct from primary systemic lupus erythematosus. Similarly to idiopathic lupus, dile can be diveded into systemic sle, subacute cutaneous scle and chronic. Druginduced lupus dil refers to an idiosyncratic side effect of numerous, apparently unrelated, medications, in which symptoms overlap with those of systemic lupus erythematosus. Alternative treatments for systemic lupus erythematosus. However, measuring the ana because someone is getting a drug e. Drug induced systemic lupus erythematosus sle is defined by the occurrence of sle symptoms following continuous administration of a drug 3 weeks to 2 years and by the immediate reversal of the.
Druginduced lupus erythematosus information mount sinai. The only drug i am on and have ever been on is zoloft. Systemic lupus erythematosus sle is a common autoimmune disease, with an incidence in europe and north america varying between 1 and 10 cases per 100 000 per year. It can occur with a wide variety of agents that result in the generation of antihistone or other types of antibodies. Differential treatments based on druginduced gene expression. Druginduced, rossapositive cutaneous lupus erythematosus. As in idiopathic or usualtype lupus erythematosus le, there are three categories recognised. Drug induced lupus dil is a disorder with clinical, histological, and immunological features similar to idiopathic systemic lupus erythematosus, but that occurs when certain drugs are taken and resolved after discontinuation of the offending agent. Objective to study the clinical and immunopathologic findings of drug induced, rossapositive cutaneous lupus erythematosus cle. Isoniazid, an antituberculosis drug, can cause systemic lupus erythematosus sle. Background sulphasalazine ssz has been reported to cause drug induced systemic lupus erythematosus sle, but diagnosis of this complication in the context of rheumatoid arthritis ra is difficult. To access free multiple choice questions on this topic, click here. The mechanism or mechanisms involved in druginduced lupus remain uncertain. The use of the abbreviation sle means idiopathic sle throughout this chapter.
How is druginduced lupus erythematosus differentiated. I would change your recommendation about checking ana. Specific classification criteria for drug induced lupus have not been published, and no published data address differences between adult and pediatric drug induced lupus. While the exact cause of lupus is unknown, there is significant evidence that some medications may cause lupus in some cases. Evolving and expanding scope of lupusinducing drugs. Drug induced lupus means that the disease systemic lupus erythematous was caused by a certain drug.
This book is attractive to both the investigative community and clinicians. M the nature of druginduced systemic lupus erythematosus, presented. Drug induced lupus erythematosus has features distinct from primary systemic lupus erythematosus. Drug induced lupus is the presence of sle manifestations occurring after exposure to specific medications, listed in table 1084. My pharmacist was the one who figured it out because he took the time to read the fulllength medication documentation from the manufacturer. However, various theories have been developed regarding the pathogenesis of druginduced lupus. Related conditions are drug induced cutaneous lupus and drug induced. Patients with drug induced lupus have very high titers e. Many pharmacologic agents have been associated with a lupuslike.
Drug induced lupus erythematosus is an autoimmune disorder similar to systemic lupus erythematosus sle caused by chronic use of certain drugs. The following products are considered to be alternative treatments or natural remedies for systemic lupus erythematosus. The renal biopsy was important as it pointed to ain as the primary nephrological pathology, rather than lupus nephritis. Systemic refers to ability to affect different systems. In lupus, the bodys immune system, which normally functions to protect against foreign invaders, becomes. Evolving and expanding scope of lupusinducing drugs annals. Acute interstitial nephritis and druginduced systemic. Drug induced lupus differs from sle by the following features.
Pdf systemic rheumatic symptoms occur with widely different. Drug induced lupus dile is a temporary form of lupus that is brought on by a reaction to medication. Those drugs that have reported associations with drug induced lupus dil do so to differing degrees, from relatively rigorous clinical and mechanistic investigations to more limited case reports. Pdf among the numerous idiopathic immunemediated diseases that can be. Druginduced lupus erythematosus actas dermosifiliograficas. Although the pathogenesis of dil is not well understood, a genetic predisposition may play a role in the case of certain drugs, particularly those. A suspected case of isoniazid induced systemic lupus erythematosus was confirmed by the presence of serum antinuclear antibodies. In the 1950s and 1960s geritol tonic was heavily advertised on television as a fast cureall if youre feeling weak and rundown, tired or nervous. There are no standardized diagnostic criteria for drug induced lupus erythematosus, but in such cases there must have been continuous exposure to a phar. Although the term is frequently used alone to designate lupus vulgaris and sometimes lupus erythematosus, without a modifier it has no meaning. Causes of systemic lupus erythematosus sle the most common. Druginduced lupus definition of druginduced lupus by.
1174 672 1052 59 733 1513 1506 327 393 17 135 474 236 96 725 361 1121 1301 564 1281 190 541 185 75 1376 77 1157 1294 779 1008 1418 967 1549 212 174 1387 405 733 863 844 997 249 864 102 956 235 808 1312