Drug Induced Lupus Erythematosus

Drug-induced lupus erythematosus is a disorder that is brought on by a reaction to a medicine. In drug induced lupus not all the typical features of systemic lupus erythematosus are seen, with renal and nervous system involvement being unusual. It usually resolves on stopping the drug.

The most common medicines known to cause drug-induced lupus erythematosus are:

• Isoniazid
• Hydralazine
• Procainamide

Other less common drugs may also cause the condition. These may include:

• Anti-seizure medications
• Capoten
• Chlorpromazine
• Tumor-necrosis factor (TNF) alpha inhibitors (such as etanercept, infliximab and adalimumab)
• Methyldopa
• Minocycline
• Penicillamine
• Quinidine
• Sulfasalazine

Symptoms tend to occur after taking the drug for at least 3 to 6 months.

Findings on Physical Examination: 

Extracutaneous physical findings in Drug Induced Lupus Erythematosus can include the following:

• Splenomegaly
• Hepatomegaly
• Inflammation of the serous membranes that surround the lungs and pleural cavity walls (pleurisy)
• Fever
• Inflammation of the fibroserous membranes that cover the heart and the initial part of the great vessels (ie, pericarditis)
• Cerebritis (rarely)
• Episcleritis (rarely) 
• Nephritis (rarely)

Skin findings are apparent in approximately 25% of all patients diagnosed with Drug Induced Lupus Erythematosus. Note, however, that certain manifestations typical in persons with SLE are not usually observed in persons with Drug Induced Lupus Erythematosus. 

Patients with Drug Induced Lupus Erythematosus (unlike patients with SLE) typically do not have the following:

• Mucosal ulcers
• Hair loss (alopecia)
• Circular (discoid) plaques
• Photosensitivity (with the exception of thiazide-induced subacute lupuslike syndrome)

Compared with patients who have SLE, patients with Drug Induced Lupus Erythematosus present with a higher prevalence of the following:

• Purpura
• Erythema nodosum (painful nodules, usually on the extremities)
• Erythematous papules (typically on sun-exposed areas)

Management:

Most of the time, symptoms go away within several days to weeks after stopping the medicine that caused the condition.

Treatment may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to treat arthritis and pleurisy
• Corticosteroid creams to treat skin rashes
• Antimalarial drugs (hydroxychloroquine) to treat skin and arthritis symptoms