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

Bojinca,Violeta  Claudia; Bojinca,Mihai; Gheorghe,Madalina; Birceanu,Adelina; Iosif,Cristina  Ileana; Balanescu,Serban  Mihai; Balanescu,Andra  Rodica

doi:10.3892/br.2018.1098

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

Authors:
- Violeta Claudia Bojinca
- Mihai Bojinca
- Madalina Gheorghe
- Adelina Birceanu
- Cristina Ileana Iosif
- Serban Mihai Balanescu
- Andra Rodica Balanescu
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Affiliations: Department of Internal Medicine and Rheumatology, ‘Sfanta Maria’ Hospital, 011172 Bucharest, Romania, Clinical Department 5, Carol Davila University of Medicine and Pharmacy, 030167 Bucharest, Romania, Department of Pathology ‘Sfanta Maria’ Hospital, 011172 Bucharest; 5Department of Cardiology, ‘Elias’ Hospital, 011461 Bucharest, Romania
Published online on: May 16, 2018 https://doi.org/10.3892/br.2018.1098
Pages: 37-41
Copyright: © Bojinca et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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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.

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