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A Case of Rhupus with Rowell Syndrome

Authors Almansouri AY, Alzahrani ZA

Received 8 April 2020

Accepted for publication 21 May 2020

Published 9 June 2020 Volume 2020:12 Pages 91—96


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Chuan-Ju Liu

Abdulrahman Y Almansouri,1 Zeyad A Alzahrani2

1Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia; 2Division of Rheumatology, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia

Correspondence: Abdulrahman Y Almansouri P.O. Box 7194, Jeddah 21462, Saudi Arabia
Tel +966 565656486

Abstract: We report a case of 30-year-old female who presented initially with hair loss, photosensitive malar rash, morning stiffness and synovitis. She was diagnosed with Rhupus syndrome based on clinical and laboratory findings. Few months after starting hydroxychloroquine, esomeprazole and azathioprine, and failing methotrexate (because of erosive pill-induced esophagitis), she presented with generalized maculopapular dusky reddish rash in her body, back and extremities. Her anti-double stranded-DNA, anti-nuclear antibody, anti-Ro/SSA and anti-La/SSB were positive. Anti-cyclic citrullinated peptide antibody was moderately positive. She had low complements: C3 and C4. Herpes simplex IgM and mycoplasma tested negative. Skin biopsy from right arm showed evidence of erythema multiform. She met the criteria for the diagnosis of Rowell syndrome. We managed her with hydroxychloroquine, prednisolone, mycophenolate mofetil and topical agents and discontinued esomeprazole. We also review the management of Rowell syndrome in the literature.

Keywords: Rowell syndrome, systemic lupus erythematosus, erythema multiform, cutaneous lupus erythematosus, rheumatoid arthritis

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