We present a case of DILE presenting with cardiac tamponade associated with infliximab use that resolved with discontinuation of the medication and administration of high-dose steroids. [ncbi.nlm.nih.gov]

CASE REPORT Case 1: A 54-year-old male patient with hypertension, taking hydralazine for four years, had been presenting with been presenting erythematous, scaly and edematous papules on the trunk, back, upper limbs and sun-exposed areas for the last [doi.org]

• Weight Loss

  These symptoms include fever, malaise, weight loss, arthritis, arthralgia and myalgia 3. Symptoms generally worsen the longer the patient is maintained on the suspect medicine 3. [medsafe.govt.nz]

  Stymptoms may include, fever, loss of appetite, malaise, weight loss, skin rash, joint pain and swelling, blurred vision, and chest pain. [ozarkderm.com]

  They may include: Muscle pain Joint pain, sometimes with swelling Fever Tired feeling Weight loss Inflammation around the lungs or heart that causes pain or discomfort You may feel these as soon as 3 weeks after you start taking the drug. [webmd.com]

  She reports significant weight loss despite eating a normal diet. She reports that she sunburns very easily and has a facial rash that is hard to cover with makeup. [medbullets.com]

  Symptoms Blurred vision Fever General ill feeling (malaise) Joint pain Joint swelling Loss of appetite Pleuritic chest pain Skin rash Gets worse with sunlight "Butterfly" rash across bridge of nose and cheeks Weight loss Exams and Tests The health care [lutheranhealthcare.org]

• Epilepsy

  Her history includes epilepsy diagnosed at age 16 when she developed generalised tonic-clonic seizures. Her EEG was consistent with an idiopathic generalised epilepsy. [nzma.org.nz]

  Referrals are made to genetics clinics for a variety of reasons, including birth defects, developmental delay, autism, epilepsy, short stature, in the United States, physicians who practice clinical genetics are accredited by the American Board of Medical [wikivisually.com]

• Severe Pain

  These NSAIDs may be suitable if your joint or muscle pain is mild. For more severe pain you will need stronger medication prescribed by your doctor. [your.md]

• Ankle Swelling

  facial redness and swelling. [your.md]

• Pleural Effusion

  Title A Case of Drug-Induced Lupus Erythematosus Secondary to Trimethoprim/Sulfamethoxazole Presenting with Pleural Effusions and Pericardial Tamponade. [hsrc.himmelfarb.gwu.edu]

  Patients who initially have pleural effusions while receiving drugs capable of inducing lupus erythematosus should have the fluid analyzed for lupus erythematosus cells to help clarify the cause of the effusion. [ncbi.nlm.nih.gov]

  Pleural effusions or pericarditis may occur [ 1, 3, 6, 8 ]. Such effusions may be severe enough to warrant a differential diagnosis. Clinical and serologic features may vary according to the specific drug used. [omicsonline.org]

  […] endocarditis characterized by thrombi on the mitral or aortic valves (LSE in SLE) Raynaud phenomenon Prognosis often have recurrent flares Presentation Symptoms constitutional symptoms fatigue, fever, or weight loss arthralgias serositis pericarditis, pleural [medbullets.com]

  Isoniazid (INH)-Induced Eosinophilic Exudative Pleural Effusion and Lupus Erythematosus, A Clinical Reminder of Drug Side Effects. Bull NYU Hosp Jt Dis. 2011;69(2):181-4. [On-line information]. [labtestsonline.it]

• Cough

  She was admitted to our hospital in July 1990, complaining of productive cough and general fatigue. [doi.org]

  Symptoms of infection may sometimes be similar to a flare up of lupus and include: high temperature (fever) of 38C (100.4F) or above new onset of cough, phlegm or breathlessness burning on passing urine or blood in the urine (haematuria) diarrhoea You [your.md]

  The chest pain is aggravated by coughing, deep breathing, and certain changes in body position. The heart muscle itself rarely can become inflamed ( carditis ). [rxlist.com]

• Pleuritic Pain

  pain or a pleuritic rub during auscultation OR Pericarditis documented by ECG, a rub during auscultation, or evidence of a pericardial effusion. [amboss.com]

  […] be present: Malar rash Discoid rash Photosensitivity Oral ulcers Nonerosive arthritis - involving 2 or more peripheral joints, characterized by tenderness, swelling, or effusion Pleuritis or pericarditis Defined as: Pleuritis - convincing history of pleuritic [straighthealthcare.com]

• Thrombosis

  Strokes may be due to vasculitis or thrombosis associated with APLS. [patient.info]

  DeBandt looked at the only case of thrombosis in a patient with anticardiolipin antibodies and anti–TNF-α–induced DILE, although half of the anti–TNF-α–related DILE patients studied (12) had anticardiolipin antibodies. [17] The mechanism by which anti–TNF-α [emedicine.com]

  Chlorpromazine-induced APAs are not associated with thrombosis while those APAs associated with procainamide and quinidine/quinine have been associated with thrombosis. A. [clinicaladvisor.com]

  […] complement factors and cytokines also play a key role environmental triggers include sunlight (photosensitive rash), infection, and drugs ( HIP ) H ydralazine I soniazid P rocainamide Associated conditions antiphospholipid syndrome increased risk of thrombosis [medbullets.com]

  The patient with deep vein thrombosis also had positive ACL antibodies. [arthritis-research.biomedcentral.com]

• Myalgia

  After a week of this occasional reintroduction, polyarthralgias with marked functional limitation, widespread myalgia and petechiae in the legs associated with other manifestations reappeared. [academic.oup.com]

  The common features were fever, arthralgia, myalgia, serositis, and the presence of anti-histone autoantibodies. [ncbi.nlm.nih.gov]

  These symptoms include fever, malaise, weight loss, arthritis, arthralgia and myalgia 3. Symptoms generally worsen the longer the patient is maintained on the suspect medicine 3. [medsafe.govt.nz]

• Joint Swelling

  Symptoms Blurred vision Fever General ill feeling (malaise) Joint pain Joint swelling Loss of appetite Pleuritic chest pain Skin rash Gets worse with sunlight "Butterfly" rash across bridge of nose and cheeks Weight loss Exams and Tests The health care [lutheranhealthcare.org]

  Symptoms Symptoms may include: Fever General ill feeling (malaise) Joint pain Joint swelling Loss of appetite Pleuritic chest pain Skin rash on areas exposed to sunlight Exams and Tests The health care provider will do a physical exam and listen to your [mountsinai.org]

  On examination, a patient may have low-grade fever, rash, joint swelling, hepatomegaly, and signs of pleuropericarditis. [clinicaladvisor.com]

  Arthralgia: Joint and muscle pains are common, often with early morning stiffness. Joint swelling is unusual and the arthritis is usually non-erosive. [patient.info]

  Joint and muscle pain: Joints may be painful, red, and warm. They may swell. Morning stiffness may also be felt. Lupus arthritis often occurs on both sides of the body at the same time. [northshore.org]

• Joint Deformity

  Some patients develop joint deformity and subluxation when tendons and peri-articular soft tissues are affected (Jaccoud's arthropathy). Peripheral, symmetrical, flitting polyarthritis is typical. Secondary fibromyalgia is common. [patient.info]

• Seizure

  Her history includes epilepsy diagnosed at age 16 when she developed generalised tonic-clonic seizures. Her EEG was consistent with an idiopathic generalised epilepsy. [nzma.org.nz]

  They include: Antibiotics Medicines to treat fungal infections High blood pressure medication Medicines to treat inflammation Arthritis medication Medicines to treat seizures Not everyone who takes these drugs will develop drug-induced lupus. [webmd.com]

  These may include: Anti-seizure medications Capoten Chlorpromazine Etanercept Infliximab Methyldopa Minocycline Penicillamine Quinidine Sulfasalazine Symptoms tend to occur after taking the drug for at least 3 to 6 months. [lutheranhealthcare.org]

  Renal disorder Persistent proteinuria ( >0.5 mg/day) OR Cellular casts (red cells, hemoglobin, granular, tubular, or mixed) Neurologic disorder : Seizures OR psychosis ; both in the absence of offending drugs or known metabolic derangements Laboratory [amboss.com]

  […] lining around the lungs (pleuritis) or inflammation of the lining around the heart that causes chest pain, which is worse with deep breathing (pericarditis) Kidney disorders - persistent protein or cellular casts in the urine Neurologic disorders - seizures [straighthealthcare.com]

• Headache

  Side effects of hydroxychloroquine are rare but may include: indigestion diarrhoea headaches skin rashes Hydroxychloroquine may cause more serious side effects in a small number of people. [your.md]

  Headaches: These are usually related to stress and tension but can be related to a lupus flare. Many people who have lupus get migraine headaches. Other symptoms Raynaud's phenomenon: Some people with lupus have Raynaud's phenomenon. [northshore.org]

  […] erythematous butterfly rash on cheeks/nose and spares nasolabial fold) discoid lesions (erythematous raised plaques with keratotic scale and follicular plugging) photosensitive rash oral ulcers neurologic findings behavioral changes stroke seizures headaches [medbullets.com]

  The side effects commonly seen are headache, mood swings, fluid and electrolyte imbalance, insomnia, peptic ulcers, and urticaria. 36,37 Hydroxychloroquine: The dose commonly used is 400 mg once or twice daily. [uspharmacist.com]

  Symptoms include headaches, dizziness, mild confusion or memory problems, vision problems, and changes in your mood. It can lead to more serious health issues, such as seizures or a stroke. [familydoctor.org]

• Confusion

  DILE Should Not Be Confused With Medication Side Effects Drug-induced lupus should not be confused with the drug side-effects that often occur after short-term therapy for gastrointestinal, neurologic, or allergic symptoms. [web.archive.org]

  Note : DILE symptoms should not be confused with ordinary short-term side effects of medications. Side-effects usually occur within a few hours or days of starting a medication. [womens-health-advice.com]

  500,000 cases of ILE in the United States may be attributed to DILE. 1 In order to initiate appropriate prompt treatment, it is critical to distinguish DILE from ILE, both clinically and serologically. 8 Given the similarity in their symptoms, DILE can be confused [rheumatologyadvisor.com]

  It is important not to confuse the symptoms of drug induced erythematosus with medication side effects. Medication side effects typically occur within a few hours or days of consuming the medication. [findatopdoc.com]

  You may also have feelings of sadness, fear, confusion, and anger. Some people who have lupus have bouts of depression because of the challenges of living with this disease. [familydoctor.org]

• Convulsions

  This is because this type of medication is very powerful and can cause side effects such as: loss of appetite vomiting diarrhoea swollen gums bruising or bleeding more easily convulsions headache acne extra hair growth weight gain The exact side effects [your.md]

  Brain irritation (manifested by seizures [convulsions] and/or psychosis, referred to as "lupus cerebritis") Blood-count abnormalities: low white blood count (WBC) or red blood count (RBC), or platelet count on routine complete blood count testing; leukopenia [rxlist.com]

• Kidney Failure

  LUPUS NEPHRITIS Some people with SLE have abnormal immune deposits in the kidney cells. This leads to a condition called lupus nephritis. People with this problem may develop kidney failure. They may need dialysis or a kidney transplant. [nlm.nih.gov]

  Kidney inflammation in SLE (lupus nephritis) can cause leakage of protein into the urine, fluid retention, high blood pressure, and even kidney failure. This can lead to further fatigue and swelling ( edema ) of the legs and feet. [rxlist.com]

  These may include kidney disease and kidney failure, or atherosclerosis (build-up in the arteries), which can lead to a heart attack or stroke. It is important to see your doctor regularly for check-ups and maintain good health. [familydoctor.org]

  Complications of lupus SLE can sometimes cause serious complications, such as kidney failure or heart disease, and the treatment may make a person vulnerable to serious infections. [your.md]

Systemic Lupus Erythematosus (SLE) Workup. (19 September 2016 updated.) Available online at http://emedicine.medscape.com/article/332244-workup. Accessed March 27, 2017. Fonti utilizzate nelle precedenti revisioni (2003 August). [labtestsonline.it]

[…] of patients on hydralazine therapy have a positive ANA yet do not have SLE. 20 On the other hand, in patients who report common symptoms while receiving hydralazine, close monitoring and subsequent ANA levels plus antihistone antibodies and other lab workup [consultant360.com]

Associated with antiphospholipid antibodies (cerebrovascular disease, seizures, chorea) and NMDA-receptor antibodies (neurocognitive defects). [2,11] Treatment - workup and treatment should be similar to that in non-SLE patients presenting with the same [straighthealthcare.com]

SLE: Joint radiography Chest radiography and chest CT scanning Echocardiography Brain MRI/MRA Cardiac MRI Procedures Procedures that may be performed in patients with suspected SLE include the following: Arthrocentesis Lumbar puncture Renal biopsy See Workup [emedicine.medscape.com]

• Colitis

  (C, D) : Resolution of symptoms after 4 weeks of drug discontinuation Case 2: A 37-year-old male patient, bearer of ulcerative colitis, started on infliximab at a dose of 5 mg/kg. [doi.org]

• Pleural Effusion

  Title A Case of Drug-Induced Lupus Erythematosus Secondary to Trimethoprim/Sulfamethoxazole Presenting with Pleural Effusions and Pericardial Tamponade. [hsrc.himmelfarb.gwu.edu]

  Patients who initially have pleural effusions while receiving drugs capable of inducing lupus erythematosus should have the fluid analyzed for lupus erythematosus cells to help clarify the cause of the effusion. [ncbi.nlm.nih.gov]

  Pleural effusions or pericarditis may occur [ 1, 3, 6, 8 ]. Such effusions may be severe enough to warrant a differential diagnosis. Clinical and serologic features may vary according to the specific drug used. [omicsonline.org]

  […] endocarditis characterized by thrombi on the mitral or aortic valves (LSE in SLE) Raynaud phenomenon Prognosis often have recurrent flares Presentation Symptoms constitutional symptoms fatigue, fever, or weight loss arthralgias serositis pericarditis, pleural [medbullets.com]

  Isoniazid (INH)-Induced Eosinophilic Exudative Pleural Effusion and Lupus Erythematosus, A Clinical Reminder of Drug Side Effects. Bull NYU Hosp Jt Dis. 2011;69(2):181-4. [On-line information]. [labtestsonline.it]

Herein we report the first case of DILE in a 68-year-old woman who presented with arthralgia, myalgia and prolonged thrombocytopenia after receiving capecitabine and bevacizumab combination treatment as palliative treatment for metastatic colon cancer [ncbi.nlm.nih.gov]

Clinical results have been published more fully by McEntegert et al. 12 Table 1 Proportion of patients continuing treatment over the five years DRUG TOXICITY Side effects were common, although not all resulted in withdrawal from treatment (table 2 ). [ard.bmj.com]

Prognosis Special patient groups [amboss.com]

Prognosis The prognosis has improved with earlier recognition and improved management. The five-year survival rate is over 90%. [patient.info]

Outlook (Prognosis) Most of the time, drug-induced lupus erythematosus is as severe as SLE. The symptoms often go away within a few days to weeks after stopping the medicine you were taking. Avoid taking the drug that caused the reaction in future. [lutheranhealthcare.org]

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. [mclarenhealthplan.org]

When confronted with sterile exudative effusions, clinicians should strongly consider non-infectious etiologies. [ncbi.nlm.nih.gov]

Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]

[…] individuals display all of these problems Chronic, relapsing, inflammatory, and often febrile multisystemic disorder of connective tissue, characterized principally by involvement of the skin, joints, kidneys, and serosal membranes; it is of unknown etiology [icd9data.com]

The exact cause is still unknown, but a genetic predisposition, as well as hormonal and immunological influences, are considered likely etiological factors. [amboss.com]

] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Lopez P, Mozo Gutierrez C, Suarez A (2003) Epidemiology of systemic lupus erythematosus in a northern Spanish population: gender and age influence on immunological features. [link.springer.com]

Epidemiología – Epidemiology is the study and analysis of the patterns, causes, and effects of health and disease conditions in defined populations. [wikivisually.com]

Furthermore, DILE can be differentiated from SLE by epidemiological factors. SLE tends to occur in young African-American females, while DILE is most commonly a disease of elderly Caucasians with no sexual predilection. [ncbi.nlm.nih.gov]

[…] erythematosus (SLE) is a systemic autoimmune disease characterized by acute flares, commonly presenting with rash, joint pain, and fever multiple organ systems are involved, including renal, neurologic, dermatologic, cardiovascular, and hematologic Epidemiology [medbullets.com]

Pathophysiology The pathophysiology of DILE is not well known. [ncbi.nlm.nih.gov]

Additional research efforts are necessary to get a better understanding of the pathophysiology and pharmacogenetics of DILE. follow @RheumAdvisor References Ho CH, Chauhan K. Lupus erythematosus, drug-induced. StatPearls [Internet]. [rheumatologyadvisor.com]

TNF α) (etanercept, infliximab, adalimubab) 13 Valproate Voriconazole Drugs that cause flares of SLE are as follows: Cimetidine Hydralazine Hydrochlorothiazide Mesantoin P -Aminobenzoic acid (PABA) Penicillin Phenylbutazone Sulfonamides Terbinafine 14 Pathophysiology [oralmaxillo-facialsurgery.blogspot.com]

SUMMARY OF KEY PARAMETERS OF SYSTEMIC LUPUS ERYTHEMATOSUS MARKET, THROUGH 2018 CHAPTER 3 - OVERVIEW SIGNS AND SYMPTOMS TYPES OF LUPUS SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) CUTANEOUS LUPUS ERYTHEMATOSUS (CLE) DRUG-INDUCED LUPUS NEONATAL LUPUS ERYTHEMATOSUS PATHOPHYSIOLOGY [gii.co.jp]

See also the following Medscape articles: Pathophysiology SLE is an autoimmune disorder characterized by multisystem inflammation with the generation of autoantibodies. [emedicine.medscape.com]

The goals of the treatment plan are to Prevent flares Treat flares when they occur Reduce organ damage and other problems Treatments may include drugs to Reduce swelling and pain Prevent or reduce flares Help the immune system Reduce or prevent damage [icdlist.com]

Moreover, the effect seemed independent of immune suppression, implying that Plaquenil can directly act to prevent the blood clots. [medicinenet.com]

Can lupus be prevented or avoided? You cannot avoid lupus since the cause of it is unknown. However, you may be able to help prevent flares. [familydoctor.org]

List Of Drugs And Associated Risk Of Drug Induced Lupus Antiarrhythmics Drugs to prevent harmful heart arrhythmias Procainamide (Pronestyl). Risk: high Quinidine (Quinaglute). Risk: moderate Disopyramide (Norpace). [womens-health-advice.com]

Taking medicine to help prevent osteoporosis caused by corticosteroids. Preventing plaque in the arteries (atherosclerosis) that can be made worse by corticosteroids. [northshore.org]