Stevens‑Johnsons syndrome or drug‑induced lupus ‑ a clinical dilemma: A case report and review of the literature

Abstract

Tumor necrosis factor inhibitors are the first biological agents used in the treatment of rheumatoid arthritis (RA) to have yielded satisfactory results in terms of clinical improvement and radiologic progression, but they are also associated with the possibility of occurrence of a number of autoimmune systemic events [drug-induced lupus (DIL), vasculitis, sarcoidosis] and localized adverse events [uveitis, psoriasis, interstitial lung disease, erythema multiforme including the major form Stevens-Johnson syndrome (SJS)]. During treatment with TNF inhibitors, many patients develop positivity for antinuclear, antihistone and anti-double stranded DNA antibodies, though only a minority of patients will develop clinical manifestations and approximately less than 1% will fulfill the classification criteria for systemic lupus erythematosus. Mucocutaneous manifestations are the most frequent manifestations of DIL following treatment with TNF inhibitors, and can be severe and occasionally difficult to differentiate from erythema multiforme/SJS. Stopping the causative drug (the TNF inhibitor) and general supportive measures are usually sufficient in mild forms, but in moderate to severe forms, systemic glucocorticoids and sometimes immunosuppressive drugs are required. The present report presents the case of a patient with rheumatoid arthritis who developed severe recurrent cutaneous reactions and positive autoantibodies during TNF inhibitor treatment, with difficulties in differential diagnosis and treatment. A review of the literature is also presented.

Toxic Epidermal Necrolysis after COVID-19 mRNA-1237 Vaccination

“…PEG is reported to have various anaphylactic type reactions, including death in severe cases, but PEG has not been reported to be associated directly or individually with SJS/TEN [5]. However, there are very rare case reports of SJS/TEN occurring with anti-tumor necrosis factor-PEG and recombinant erythropoietin-PEG [1,6]. Our patient's history of having had PEG 3500 after this incident without reaction decreases suspicion that this is the ingredient that triggered her reaction.…”

“…Dermatology recommended hydroxyzine 25 mg nightly, cetirizine 10 mg twice daily, and a dexamethasone 0.1 mg/mL rinse for mouth lesions with an antiseptic diluted chlorohexidine rinse. Over the course of her admission to our hospital, total body surface area (TBSA) coverage was estimated at 30%-40%, suggesting progression to toxic epidermal necrolysis (TEN) [1]. Psychiatry was also consulted for management of the patient's psychiatric medications and her modafinil and aripiprazole were stopped on suspicion of being a cause of her TEN.…”

İlaç alerjisi olan hastalarda otoantikor sıklığı

“…The most common drug-induced autoimmune disease is iatrogenic drug-induced lupus [19,20]. Drugs can also cause rheumatoid arthritis, polymyositis, dermatomyositis, myasthenia gravis, pemphigus, pemphigoid, membranous glomerulonephritis, autoimmune hepatitis, autoimmune thyroiditis, autoimmune hemolytic anemia, and Sjogren's syndrome [21][22][23].…”

Update on ophthalmic manifestations of systemic lupus erythematosus: pathogenesis and precision medicine

“…Hydralazine and procainamide are the most common causes of DIL [17 ▪▪ ]. While antitumor necrosis factor agents increase production of antinuclear and anti-dsDNA antibodies in 15–80% of patients taking the biologic therapy [18], less than 1% of these patients go on to meet criteria for SLE [19]. Interferon-α, used to treat chronic viral hepatitis, multiple sclerosis, and uveitis from Behcet's disease, can be associated with adverse reactions resembling a lupus-like syndrome [20,21].…”