s-1743 and Lupus-Erythematosus--Cutaneous

Topics: Aged; Anti-Inflammatory Agents; Anti-Ulcer Agents; Antibodies, Antinuclear; Biopsy; Comorbidity; Esomeprazole; Female; Humans; Lupus Erythematosus, Cutaneous; Mometasone Furoate; Polypharmacy; Pregnadienediols; Pruritus; Remission Induction; Thiamine; Vitamin B 12; Vitamin B 6

This article introduces a new case of Rowell's syndrome, a controversial entity defined by the association of lupus erythematosus and erythema multiforme.. 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.. 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.

Topics: Adrenal Cortex Hormones; Adult; Anti-Ulcer Agents; Cheilitis; Diagnosis, Differential; Erythema Multiforme; Esomeprazole; Female; Humans; Hydroxychloroquine; Lupus Erythematosus, Cutaneous; Syndrome

Proton pump inhibitors are among the most commonly used drugs worldwide. They are considered to be largely safe and cause little side-effects. We report a 69-year-old woman who suffered from erythematous plaques 2 months after initiating therapy with esomeprazole. The diagnosis of subacute cutaneous lupus erythematosus was based on the clinical picture together with characteristic histological features of a skin biopsy specimen and the detection of anti-Ro/SSA antibodies. In particular, the temporal relationship with the onset of proton pump inhibitor therapy led to the high-level suspicion of a drug-induced pathogenesis. Strengthening the initially suspected diagnosis, the characteristic skin lesions resolved almost completely without specific therapy after discontinuation of the medication. If typical skin lesions occur in light-exposed areas in connection with the administration of PPI, the possibility of a drug-induced cutaneous lupus erythematosus should always be considered. Due to the frequent recurrence rate after renewed exposure, a new therapy with PPI should be avoided.. Protonenpumpeninhibitoren gehören zu den weltweit am häufigsten verwendeten Arzneimitteln. Sie gelten als weitgehend sicher und nebenwirkungsarm. Wir berichten über eine 69-jährige Patientin, bei der 2 Monate nach Einleitung einer Therapie mit Esomeprazol anuläre erythematöse Plaques überwiegend an lichtexponierten Körperstellen auftraten. Anhand des klinischen Bildes, dem histologischen Befund eines Hautbioptats und dem Nachweis von Anti-Ro/SSA-Antikörpern wurde die Diagnose eines subakut kutanen Lupus erythematodes gestellt. Insbesondere der zeitliche Zusammenhang mit dem Beginn der Protonenpumpeninhibitor-Therapie begründete den hochgradigen Verdacht auf eine medikamenteninduzierte Genese. Nach Absetzen von Esomeprazol waren die charakteristischen Hautveränderungen ohne spezifische Therapie nahezu vollständig rückläufig, was die anfängliche Verdachtsdiagnose erhärtete. Beim Auftreten typischer Hautveränderungen in lichtexponierten Arealen im zeitlichen Zusammenhang mit der Einnahme von PPI sollte daher immer auch an die Möglichkeit eines medikamenteninduzierten kutanen Lupus erythematodes gedacht werden. Aufgrund der häufigen Rezidive nach erneuter Exposition sollte eine erneute Therapie mit PPI vermieden werden.

Topics: Aged; Biopsy; Esomeprazole; Female; Gastroesophageal Reflux; Humans; Lupus Erythematosus, Cutaneous; Proton Pump Inhibitors

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Autoantibodies; Biopsy; Diagnosis, Differential; Esomeprazole; Female; Gastroesophageal Reflux; Humans; Lupus Erythematosus, Cutaneous; Male; Middle Aged; Pantoprazole; Pregnancy; Proton Pump Inhibitors; Skin

Subacute cutaneous lupus erythematosus (SCLE) can be induced by numerous drugs. We report 3 cases of SCLE induced by proton pump inhibitors (PPIs).. To highlight a rare cutaneous side effect induced by a frequently prescribed drug such as a PPI.. Case 1 was a 30-year-old man who developed multiple annular plaques over the trunk and lower limbs 1 month after the initiation of pantoprazole. Antinuclear antibodies (ANA) were positive with anti-Ro/SSA and anti-La/SSB antibodies, and histology confirmed the diagnosis. Clinical improvement was achieved 8 weeks after the discontinuation of pantoprazole and the introduction of a treatment combining topical steroids and hydroxychloroquine. Lesions relapsed when pantoprazole was accidentally rechallenged. The second case was a 31-year-old woman, 28 weeks pregnant, who presented erythematous annular plaques over the trunk 7 weeks after starting esomeprazole. ANA and anti-Ro/SSA antibodies were positive, and the histology was compatible with SCLE. Fetal ultrasound was normal. She was treated with topical and oral steroids and hydroxychloroquine. Clinical improvement was achieved 4 weeks after the discontinuation of esomeprazole. The third case was a 57-year-old woman with systemic erythematosus lupus presenting annular and psoriasiform lesions on the trunk for 15 months. She was treated successively with hydroxychloroquine, azathioprine, mycophenolate mofetil and methotrexate with prednisone. A review of her drug history revealed the introduction of omeprazole a few weeks before the first appearance of skin lesions and omeprazole was contraindicated.. SCLE should systematically be suspected in case of eruption after the introduction of PPI. The risk of fetal cardiac complications is important in pregnant women.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Esomeprazole; Female; Humans; Lupus Erythematosus, Cutaneous; Male; Middle Aged; Omeprazole; Pantoprazole; Proton Pump Inhibitors