Malar rash caused by metal allergy in a patient with systemic lupus erythematosus

Kosboth, Meghavi; Chin-Loy, Anthony; Lyons, Robert H.; Wesson, Stanton K.; Reeves, Westley H.

doi:10.1038/ncprheum0464

Cited by 19 publications

(11 citation statements)

References 18 publications

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“…Contact dermatitis is caused by CD8 + and CD4 + T cells mediated delayed hypersensitivity reaction to hapten-modified MHC–peptide complexes [ 16 ], both hapten-bound and hapten-free [ 12 , 16 ]. Soluble derivatives of the metal are formed due to its ready oxidation by skin exudates, which deposit in the stratum corneum, potentially diffusing further to reach the epidermal cells: keratinocytes, lymphocytes, and Langerhans cells [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Systemic reactions might not be common, but the potential risk of nickel or the nickel–titanium combination toxicity should not be ignored [ 26 ], especially in the context of a personal clinical history suggestive of allergies in susceptible individuals. It may be relevant to assess immunological functions of patients with an implant or in close contact with a nickel-releasing material prior and post-nickel exposure [ 11 ], since a large part of the general population tests positive to skin patch testing with nickel sulfate yet remains asymptomatic, and conversely, many who complain of metal intolerance test negative [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

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Autoimmunity in connection with a metal implant: a case of autoimmune/autoinflammatory syndrome induced by adjuvants

Loyo¹,

Jara

López

et al. 2012

Autoimmun Highlights

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Autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) has been recently proposed by Shoenfeld and Agmon-Levin as a new entity that comprises several conditions: the macrophagic-myofasciitis syndrome, the Gulf War syndrome, silicosis and post-vaccination phenomena, autoimmunity related to infectious fragments, hormones, aluminum, silicone, squalene oil, and pristane. We report the case of a 23-year-old woman who developed serial episodes of high fever, extreme fatigue, transient thrombocytopenia, multiple cervical adenopathies, hepatosplenomegaly, anemia, neutropenia, severe proteinuria and urine sediment abnormalities, elevated serum ferritin levels, and transient low positive antinuclear antibodies 1 year after she had a nickel–titanium chin implant for cosmetic reasons. The clinical picture simulated a variety of probable diseases: systemic lupus erythematosus, Kikuchi–Fujimoto syndrome, adult onset Still’s disease, antiphospholipid syndrome, and hemophagocytic syndrome, among others, so she underwent an extensive medical investigation including two lymph node biopsies. She received treatment accordingly with steroids, methotrexate, and mofetil mycophenolate, with initial improvement of her symptoms, which recurred every time the dose was reduced. Two and a half years later the patient decided to retire the chin implant and afterwards all her systemic symptoms have disappeared. She remains in good health, without recurrence of any symptom and off medications until today. Albeit this patient fulfills proposed major ASIA criteria, to our knowledge it would be the first description of systemic features of autoinflammation in connection with a metal implant.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Autoimmunity in connection with a metal implant: a case of autoimmune/autoinflammatory syndrome induced by adjuvants

Loyo¹,

Jara

López

et al. 2012

Autoimmun Highlights

View full text Add to dashboard Cite

show abstract

“…Exploration of neuroprotective therapies has been ongoing in PD (Kieburtz and Ravina, 2007; Voss and Ravina, 2008; Hart et al, 2009) and HD (Emerich, 2001; Hersch and Rosas, 2008) for decades yet there have been no such trials in ET. The cellular changes that underlie ET are just now beginning to be elucidated and new knowledge should provide insights into the molecular mechanisms that underlie this disorder.…”

Section: Resultsmentioning

confidence: 99%

Treatment of Essential Tremor: Are there Issues We are Overlooking?

Louis¹

2012

Front. Neur.

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Background: Essential tremor (ET) is one of the most common neurological diseases. Although a large number of medications have been tested, there are only two first-line medications, primidone and propranolol, which is a situation that has not changed in approximately 30 years. Several recent reviews have summarized the current pharmacotherapeutic options for ET and the approach to the management of ET patients. Yet there remain a number of important issues, both scientific and clinical, that have not been broached in the literature and that have therapeutic implications. Objectives: To introduce several clinical and scientific issues that have not formally entered the published literature on the treatment of ET. Methods: In September 2011, materials for this article were gathered during a literature search of PubMed using the following terms: ET, clinical, clinical trial, treatment, medications, therapeutics. English-language articles were selected for further review. Results: The paper focuses on several topics that have received scant or no discussion in the published literature on ET therapeutics. These topics are as follows: the nature of the underlying disease pathophysiology, the presence of pathological heterogeneity, the complexity of cellular and neurochemical changes which may be underlying this disorder, the presence of clinical heterogeneity, the selection of treatment endpoints, the effects of diagnostic uncertainty, the presence of cognitive and psychiatric features in ET, the identification of possible modifiable risk factors, and the absence of any neuroprotective therapies. Conclusion: The author has identified several topics that have received scant or no discussion in the published literature on ET therapeutics. Further discussion of the issues raised here may lead to improvements in clinical trial methodologies as well as facilitate the development of fresh approaches to pharmacotherapy.

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“…The role of body piercing in inducing nickel allergy has been emphasized. [1][2][3][4][5][6][7][8] The sources of contact are mainly earrings, necklaces, and wristwatches. Some other sources of nickel exposure include food, technical and cosmetic products, prosthetic implants, invasive medical tools, jewelry, stainless steel cooking utensils, metal eyeglass frames, and environmental pollution.…”

Section: Introductionmentioning

confidence: 99%

“…However, the hapten may also cause abnormal protein folding that could lead to altered processing of self antigens, in which case the peptide associated with MHC might not be hapten bound. 8 Our objective in this study was to examine the influence of subcutaneous and oral nickel chloride in the induction of autoimmunity in immunosensitive rats.…”

Section: Introductionmentioning

confidence: 99%

Induction of autoimmunity in brown Norway rats by oral and parenteral administration of nickel chloride

Al-Mogairen

2009

Lupus

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Nickel intolerance owing to sensitization is a growing problem. The main objective of this study was to examine the relationship between nickel chloride and induction of autoimmunity in genetically susceptible rats. Thirty brown Norway rats were randomized into four treatment groups; the first and second groups received nickel chloride 4.5 mg in 0.2 ml normal saline either orally or subcutaneously, and the third and fourth groups (controls) received normal saline (0.9%) 0.2 ml through the same routes. A significant number of rats (P < 0.05) that received nickel chloride by the subcutaneous or oral routes showed a high level of serum antinuclear antibody (ANA) compared with controls. A significant number of rats (P < 0.05) that received nickel chloride by the subcutaneous route showed high serum anti-SSA, but the number of rats with anti-SSA was insignificant in the group that received nickel by the oral route. Other autoantibodies found in both groups (anti-double-stranded (ds)DNA, anti-Smith, anti-SSB) showed a gradual increase, but the number of rats with positive titers post exposure was not significant statistically. Nickel chloride exposure in the rats appeared to induce the development of autoimmunity. A longer duration following exposure to nickel chloride seems to be associated with greater risks.

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Malar rash caused by metal allergy in a patient with systemic lupus erythematosus

Abstract: The rash resolved completely with contact avoidance with the eyeglass frames.

Cited by 19 publications

References 18 publications

Autoimmunity in connection with a metal implant: a case of autoimmune/autoinflammatory syndrome induced by adjuvants

Autoimmunity in connection with a metal implant: a case of autoimmune/autoinflammatory syndrome induced by adjuvants

Treatment of Essential Tremor: Are there Issues We are Overlooking?

Induction of autoimmunity in brown Norway rats by oral and parenteral administration of nickel chloride

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