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Drug-induced lupus erythematosus
Lupus - drug induced
Drug-induced lupus erythematosus is an autoimmune disorder that is brought on by a reaction to a medicine.
Autoimmune disorder
An autoimmune disorder occurs when the body's immune system attacks and destroys healthy body tissue by mistake. There are more than 80 types of aut...
Causes
Drug-induced lupus erythematosus is similar to systemic lupus erythematosus (SLE). It is an autoimmune disorder. This means your body attacks healthy tissue by mistake. It is caused by an overreaction to a medicine.
Systemic lupus erythematosus
Systemic lupus erythematosus (SLE) is an autoimmune disease. In this disease, the body's immune system mistakenly attacks healthy tissue. It can af...
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.
Symptoms
Symptoms may include:
- Blurred vision
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Fever
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
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- Joint pain
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Joint swelling
Joint swelling
Joint swelling is the buildup of fluid in the soft tissue surrounding the joint.
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Pleuritic
chest pain
Pleuritic
Pleurisy is an inflammation of the lining of the lungs and chest (the pleura) that leads to chest pain when you take a breath or cough.
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Skin rash
that gets worse with sunlight. (It may appear as a "butterfly" rash across bridge of nose and cheeks.)
Skin rash
Rashes involve changes in the color, feeling or texture of your skin.
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Exams and Tests
The health care provider will do a physical exam and listen to your chest with a stethoscope. The provider may hear a sound called a heart friction rub or pleural friction rub.
A skin exam shows a rash.
Joints may be swollen and tender.
Tests that may be done include:
- Antihistone antibody
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Antinuclear antibody (ANA) panel
Antinuclear antibody (ANA) panel
The antinuclear antibody panel is a blood test that looks at antinuclear antibodies (ANA). ANA are substances produced by the immune system that atta...
ImageRead Article Now Book Mark Article - Complete blood count (CBC)
A chest x-ray may show signs of pleuritis or pericarditis (inflammation around the lining of the lung or heart). An ECG may show that the heart is affected.
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
ECG
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
Treatment
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
If the condition is affecting your heart, kidney, or nervous system, you may be prescribed high doses of corticosteroids (prednisone, methylprednisolone) and immune system suppressants (azathioprine or cyclophosphamide). This is rare.
When the disease is active, you should wear protective clothing and sunglasses to guard against too much sun.
Outlook (Prognosis)
Most of the time, drug-induced lupus erythematosus is not as severe as SLE. The symptoms often go away within a few days to weeks after stopping the medicine you were taking. Rarely, kidney inflammation (nephritis) can develop with drug-induced lupus caused by TNF inhibitors. Nephritis may require treatment with prednisone and immunosuppressive medicines.
Avoid taking the drug that caused the reaction in future. Symptoms are likely to return if you do so. Get regular eye exams to detect any complications early.
Possible Complications
Complications may include:
- Infection
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Thrombocytopenia
purpura -- bleeding near the skin surface, resulting from a low number of platelets in the blood
Thrombocytopenia
Thrombocytopenia is any disorder in which there is an abnormally low amount of platelets. Platelets are parts of the blood that help blood to clot. ...
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Hemolytic anemia
Hemolytic anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Normally, red ...
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Myocarditis
Myocarditis
Myocarditis is inflammation of the heart muscle. The condition is called pediatric myocarditis when it occurs in children.
ImageRead Article Now Book Mark Article - Pericarditis
- Nephritis
When to Contact a Medical Professional
Call your health care provider if:
- You develop new symptoms when taking any of the medicines listed above.
- Your symptoms do not get better after you stop taking the medicine that caused the condition.
Prevention
Watch for signs of a reaction if you are taking any of the drugs that can cause this problem.
References
Callen JP. Drug-induced subacute cutaneous lupus erythematosus. Lupus. 2010 ; 19:1107-11. PMID: 20693204 www.ncbi.nlm.nih.gov/pubmed/20693204 .
Patel DR, Richardson BC. Drug-induced lupus. In: Hochberg MC, Stillman AJ, Smolen JS, Weinblatt, ME, and Weisman MH, eds. Rheumatolgy . 6th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 132.
Wright B, Bharadwaj S, Abelson A. Systemic lupus erythematosus. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine . 2nd ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 13.
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Lupus, discoid - view of lesions on the chest - illustration
Lupus, discoid - view of lesions on the chest: This close-up picture of the neck clearly shows the typical rounded appearance of discoid lupus. The whitish appearance is caused by scaling. The two dark spots are biopsy sites and are not part of the disease.
Lupus, discoid - view of lesions on the chest
illustration
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Lupus, discoid on a child's face - illustration
The round or disk shaped (discoid) rash of lupus produces red, raised patches with scales. The pores (hair follicles) may be plugged. Scarring often occurs in older lesions. The majority (approximately 90%) of individuals with discoid lupus have only skin involvement as compared to more generalized involvement in systemic lupus erythematosis (SLE).
Lupus, discoid on a child's face
illustration
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Lupus, discoid on the face - illustration
The rash of lupis is round or disk shaped (discoid) and is characterized by red, raised patches with adherent scales. The skin pores (follicles) may be plugged, and scarring often occurs in older lesions. Approximately 90% of individuals with discoid lupus have only skin involvement as compared to more generalized involvement in systemic lupus erythematosis (SLE).
Lupus, discoid on the face
illustration
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Antibodies - illustration
Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.
Antibodies
illustration
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Lupus, discoid - view of lesions on the chest - illustration
Lupus, discoid - view of lesions on the chest: This close-up picture of the neck clearly shows the typical rounded appearance of discoid lupus. The whitish appearance is caused by scaling. The two dark spots are biopsy sites and are not part of the disease.
Lupus, discoid - view of lesions on the chest
illustration
-
Lupus, discoid on a child's face - illustration
The round or disk shaped (discoid) rash of lupus produces red, raised patches with scales. The pores (hair follicles) may be plugged. Scarring often occurs in older lesions. The majority (approximately 90%) of individuals with discoid lupus have only skin involvement as compared to more generalized involvement in systemic lupus erythematosis (SLE).
Lupus, discoid on a child's face
illustration
-
Lupus, discoid on the face - illustration
The rash of lupis is round or disk shaped (discoid) and is characterized by red, raised patches with adherent scales. The skin pores (follicles) may be plugged, and scarring often occurs in older lesions. Approximately 90% of individuals with discoid lupus have only skin involvement as compared to more generalized involvement in systemic lupus erythematosis (SLE).
Lupus, discoid on the face
illustration
-
Antibodies - illustration
Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.
Antibodies
illustration
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Scleroderma
(In-Depth)
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Restless legs syndrome and related disorders
(In-Depth)
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Cirrhosis
(In-Depth)
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Anemia
(In-Depth)
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Systemic lupus erythematosus
(In-Depth)
Review Date: 4/28/2015
Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
