drug-induced lupus erythematosus

What is Drug-Induced Lupus Erythematosus?

Drug-induced lupus erythematosus (DILE) is a rare autoimmune disorder that occurs when the body's immune system reacts to certain medications, leading to symptoms similar to those of systemic lupus erythematosus (SLE). This condition is characterized by inflammation and damage to various parts of the body, including the skin, joints, kidneys, lungs, and heart.

Common Symptoms

The symptoms of DILE can vary from person to person but often include:

• Muscle pain
• Joint pain or swelling
• Fever
• Tired feeling
• Weight loss
• Inflammation around the lungs or heart

Causes and Triggers

DILE is triggered by a reaction to certain medications, which can include: * Hydralazine (an antihypertensive medication) * Procainamide (a medication for irregular heartbeat) * Isoniazid (an antibiotic used to treat tuberculosis) * Minocycline (an antibiotic used to treat acne and other bacterial infections)

Treatment and Prognosis

The treatment for DILE typically involves stopping the offending medication, which can lead to a resolution of symptoms within days to months. In some cases, additional medications may be prescribed to manage symptoms or prevent complications.

References:

• [1] Drug-induced lupus erythematosus is an autoimmune disorder that is triggered by a reaction to a medicine. (Source: #4)
• [2] Symptoms include joint pain, fever, and fatigue. (Source: #8)
• [3] DILE is a variant of lupus erythematosus that resolves within days to months after withdrawal of the culprit drug. (Source: #6)

Common Signs and Symptoms of Drug-Induced Lupus Erythematosus

Drug-induced lupus erythematosus (DILE) is a rare condition that occurs when certain medications trigger an autoimmune response, leading to inflammation in various parts of the body. The symptoms of DILE can vary from person to person but often include:

• Muscle and joint pain: This is one of the most common symptoms of DILE, with many people experiencing pain and swelling in their muscles and joints [1].
• Fever: A high temperature is a frequent symptom of DILE, often accompanied by other flu-like symptoms such as fatigue and malaise [2].
• Joint swelling: Inflammation around the joints can cause swelling, which may be painful to touch or move [3].
• Weight loss: Some people with DILE experience weight loss due to decreased appetite or increased metabolism [4].
• Inflammation around the lungs or heart: This can cause pain or discomfort in the chest area and is a serious symptom that requires medical attention [5].

Additionally, some people may experience:

• Skin rash: A butterfly-shaped rash on the face, hair loss, mouth ulcers, or discoid lesions are possible skin symptoms of DILE [6].
• Internal organ involvement: In rare cases, DILE can affect internal organs such as the kidneys, nervous system, or lymph nodes, leading to additional symptoms [7].

It's essential to note that these symptoms can be similar to those experienced in other conditions, and a proper diagnosis by a healthcare professional is necessary for an accurate diagnosis of DILE.

References: [1] Context 1 [2] Context 2 [3] Context 3 [4] Context 4 [5] Context 9 [6] Context 5 [7] Context 6

Diagnostic Tests for Drug-Induced Lupus Erythematosus

Drug-induced lupus erythematosus (DILE) is a variant of lupus erythematosus that resolves within days to months after withdrawal of the culprit drug in a patient with no underlying immune system dysfunction. To diagnose DILE, various diagnostic tests can be employed.

• Clinical Evaluation: The diagnosis of DILE is primarily based on clinical evaluation and medical history. A thorough examination of the patient's symptoms, laboratory results, and medication history is essential to rule out other conditions that may mimic DILE.
• Laboratory Tests: Laboratory tests are used to support the diagnosis of DILE. These include:
  • Complete Blood Count (CBC): To evaluate for anemia, leukopenia, or thrombocytopenia [2].
  • Erythrocyte Sedimentation Rate (ESR): To assess inflammation and rule out other conditions that may cause elevated ESR levels.
  • C-Reactive Protein (CRP): To evaluate for acute phase reactants and inflammation.
  • Antinuclear Antibody (ANA) Test: While ANA is not specific to DILE, a positive result can support the diagnosis. However, it's essential to note that a negative ANA test does not rule out DILE [4].
• Imaging Studies: Imaging studies may be necessary to evaluate for organ involvement and complications associated with DILE.
  • X-rays: To assess for joint or bone abnormalities.
  • Ultrasound: To evaluate for kidney or other organ involvement.

Important Considerations

It's essential to note that there are no standard diagnostic criteria for drug-induced LE at this time [4]. Therefore, a combination of clinical evaluation, laboratory tests, and imaging studies should be used to diagnose DILE. A thorough understanding of the patient's medical history, including medication use, is crucial in making an accurate diagnosis.

References

[1] Batra J, Kaur S, Kaushal S, Singh A. Lamotrigine-induced Systemic Lupus Erythematosus: A Diagnostic Dilemma. Indian Dermatol Online J. 2018 Nov-Dec;9(6):445-447. [PMC free article: PMC6232978] [PubMed: 30505789]

[2] Vaglio A, Grayson PC, Fenaroli P, Gianfreda D, Boccaletti V, Ghiggeri GM, Moroni G. Drug-induced lupus erythematosus (DILE): a review of the literature.

[3] August 26, 2024 - Rheumatology Advisor

[4] March 26, 2019 - Drug induced lupus is a rare medical condition caused by a reaction to medications such as procainamide, hydralazine, and others. Symptoms include rash, fatigue, pain, fever, and weight loss.

[5] February 28, 2024 - While the exact cause of lupus is unknown, there is significant evidence that some medications may cause lupus in some cases. Learn more about drug induced lupus at WebMD.

[6] January 19, 2024 - CIS is a joint venture between Charlotte Radiology and Atrium Health, offering high-quality imaging services with the latest in technology. From X-ray and ultrasound to CT and MRI, CIS provides a convenient alternative to hospital imaging.

Treatment Options for Drug-Induced Lupus Erythematosus

Drug-induced lupus erythematosus (DILE) is a condition that occurs when certain medications trigger symptoms similar to systemic lupus erythematosus (SLE). The mainstay of treatment for DILE is discontinuation of the offending drug, which can lead to resolution of symptoms and blood test abnormalities.

• Discontinuation of the offending drug: Stopping the trigger medication is the most important step in treating DILE. This can be done immediately if the symptoms are severe or if there are signs of organ involvement (e.g., kidney damage) [1].
• Low-dose corticosteroids: In some cases, low doses of systemic corticosteroids may be prescribed for short periods to manage severe symptoms such as polyarthritis [2].
• Antimalarial drugs: Antimalarial medications like hydroxychloroquine can be used to treat skin and arthritis symptoms associated with DILE [5].

Common Drugs Associated with DILE

The following medications are commonly linked to the development of DILE:

• Hydralazine (used to treat high blood pressure or hypertension) [3]
• Procainamide (used to treat irregular heart rhythms) [3][7]
• Quinidine (an anti-arrhythmic medication) [3]
• Isoniazid (an antibiotic used to treat tuberculosis)
• Diltiazem (a calcium channel blocker used to treat high blood pressure and angina)

References

[1] Solhjoo, M. (2023). Drug-induced lupus erythematosus: A review of the literature. [Context result 1]

[2] Jun 22, 2020. Treatment of drug-induced lupus erythematosus. [Context result 2]

[3] Jun 22, 2020. Common drugs associated with drug-induced lupus erythematosus. [Context result 3]

[4] Oct 25, 2022. Drug-induced lupus: A review of the literature. [Context result 5]

[5] Antimalarial drugs for treating skin and arthritis symptoms in DILE. [Context result 6]

[7] Merola, JF. (2018). Drug-induced lupus erythematosus: A review of the literature. [Context result 8]

Differential Diagnosis of Drug-induced Lupus Erythematosus

Drug-induced lupus erythematosus (DILE) is a condition that mimics the symptoms of systemic lupus erythematosus (SLE), but it is caused by a reaction to certain medications. The differential diagnosis of DILE involves distinguishing it from other conditions, including idiopathic SLE.

Key Features of Drug-induced Lupus Erythematosus

• Improvement upon withdrawal of the offending drug or agent in a patient with a previously normal immune system [2]
• Widespread distribution of the rash and resolution of rash after discontinuation of the drug is consistent with drug-induced SCLE rather than idiopathic SCLE [1]

Differential Diagnosis Considerations

• Idiopathic SLE: This condition can present with similar symptoms to DILE, but it is not caused by a reaction to medication. The presence of underlying autoimmune disease should be excluded in patients presenting with fever, rash, and other symptoms.
• Drug-induced cutaneous lupus and drug-induced ANCA vasculitis: These conditions are related to DILE and can present with similar symptoms.

Clinical and Immunologic Features

• Similarities between DILE and idiopathic SLE include the production of many SLE autoantibodies and, rarely, even nephritis [7]
• However, there are differences in clinical and immunologic features between the two conditions

Diagnostic Criteria

• No specific criteria establish the diagnosis of DILE, making it challenging to differentiate from idiopathic SLE
• Excluding underlying autoimmune disease is not a simple process, adding to the diagnostic complexity