INTRODUCTION Systemic lupus erythematosus (SLE) is a chronic, relapsingremitting autoimmune disease which primarily affects the skin, joints, and kidneys but may involve any organ system, including peripheral, autonomic, or central nervous system (CNS). 1 The CNS involvement may be considered primary if directly related to SLE activity or secondary when related to treatment complications, infections, or metabolic abnormalities such as uremia. 2 The neuropsychiatric involvement in SLE (NPSLE), first mentioned by Kaposi more than 100 years ago, remains one of the main challenges facing the rheumatologist and other physicians. 2 NPSLE can precede the onset of lupus or occur at any time during its course, most frequently within the first three years. 3-6 The prevalence of CNS involvement in SLE ranges from 14% to 80%, depending on the diagnostic criteria. 7 SLE commonly involves the meninges, cranial nerves, cerebrum, spinal cord, and rarely involves the hindbrain, causing rhombencephalitis (RE), which is a syndrome of multiple causes and variable outcomes. The term "rhombencephalitis" refers to an inflammatory disease of the rhombencephalon or the hindbrain, which is composed of the pons, cerebellum, and the medulla oblongata. The term is derived from the Greek word, "rhombos" meaning a lozenge-shaped figure, plus "enkephalos", meaning the brain. 8-10 No cases of SLE and rhombencephalitis were identified in a search of the medical literature.
INTRODUCTIONDespite the allergic, inflammatory, and immunologic modulating properties of corticosteroids, acute and delayed hypersensitivity reactions have been reported. [1][2][3][4][5][6][7][8][9] There is increasing data regarding hypersensitivity reactions to systemic corticosteroids from these reports. The prevalence of hypersensitivity reactions with topical corticosteroids is 2.9 -6% [10][11][12] and less than 1% with inhaled and systemic corticosteroids. 1,2,13 Delayed hypersensitivity reactions after topical corticosteroid use have been reported for decades and they were recognized as the allergen of the year in 2005 by the American Contact Dermatitis Society. 14 Acute IgE-mediated hypersensitivity reactions occurring within one hour are characterized by urticaria and anaphylaxis; while delayed T-cell mediated reactions are characterized by urticaria and maculopapular exanthems. 14,15 Reactions may occur to the corticosteroid or to its allergens, making it difficult to identify the true culprit. 15 We identified a patient without pre-existing urticaria who exhibited hypersensitivity reactions to oral steroids (prednisone and methylprednisolone), inhaled corticosteroids/long-acting beta agonists (fluticasone/salmeterol and budesonide/formoterol), and aspirin which caused acute urticaria, angioedema, and bronchospasm. Clinicians, particularly emergency room staff, must be aware of the potential for hypersensitivity to corticosteroids and consider it in the differential diagnosis of a patient who has received corticosteroids with subsequent sequelae of a hypersensitivity reaction.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.