Drug-Induced Lupus Erythematosus Associated with Antiretroviral Therapy in a Patient with Human Immunodeficiency Virus: A Case Report

Abstract

Antiretroviral medications are the mainstay of human immunodeficiency virus (HIV) therapy and some have been in use for over 20 years. To date, there have been no reported cases of antiretroviral therapy (ART) induced drug-induced lupus erythematosus (DILE). We present a case of a 35-year-old woman who received a combination of emtricitabine, rilpivirine, and tenofovir disoproxil fumarate for HIV treatment. Three years later, she developed an extensive rash and polyarthralgia in her extremities with laboratory findings significant for positive antinuclear antibody (ANA), anti-double stranded deoxyribonucleic acid (DNA) antibody (anti-dsDNA), and anti-histone antibody titers. Her systemic symptoms and rash improved with ART discontinuation. She was later restarted on her original ART due to difficulty in tolerating a different combination therapy. A few months after restarting ART, she developed new dermatologic symptoms, worsening arthralgias, tenderness of the metacarpophalangeal and proximal interphalangeal joints of the hand, and an increase in anti-dsDNA titers to 286 IU/ml. ART was then discontinued, which led to complete resolution of her symptoms and her anti-dsDNA decreased significantly. She had no further recurrence of symptoms. Awareness of the possibility of ART-induced DILE in the right clinical setting would prompt early recognition and management of this condition.

Isoniazid-induced Lupus: When the Cure Can be Lethal

“…In therapeutic schemes as complex as the ones used with tuberculosis or HIV, awareness of the possibility of DILE in the right clinical setting would prompt early recognition and management of this condition [11]. There is no doubt that our patient developed an isoniazid induced lupus, but the combination of persistent fever and serositis remains an uncommon presentation.…”

Drug-induced systemic lupus erythematosus in a child living with HIV

“…In both the cases, diagnosis was established based on the clinical presentations, temporal association with ART introduction, and resolution of clinical symptoms on withdrawal of ART. [ 12 13 ] In one of the reports, emtricitabine, rilpivirine, and tenofovir were the offending drugs mentioned and the same were discontinued. [ 12 ] In the second report, ART was continued along with oral chloroquine, which led to clinical improvement.…”

“…[ 12 13 ] In one of the reports, emtricitabine, rilpivirine, and tenofovir were the offending drugs mentioned and the same were discontinued. [ 12 ] In the second report, ART was continued along with oral chloroquine, which led to clinical improvement. [ 13 ]…”

Diffuse connective tissue disorders in HIV-infected patients

“…A possible drug-induced lupus erythematosus was recently reported in a patient receiving a combination of emtricitabine, rilpivirine, and tenofovir disoproxil fumarate. 21 Rheumatic symptoms improved after cessation of antiretroviral therapy but re-appeared after it was restarted along with increasing anti-dsDNA titers. 150 phritis is low.…”