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Lack of efficacy: 2 case reports In a report, two adult woman [exact ages at onset not stated] were described, who exhibited lack of efficacy during treatment with chloroquine, prednisolone, mycophenolate, cyclophosphamide, azathioprine or hydroxychloroquine for lupus panniculitis [not all dosages and routes stated]. Case 1: The woman at the age of 34 years presented with oral ulcers, painful nodules over the extensor aspect of the legs, reduced vision in the eyes, mood disturbances and irritability since past 3 years. In 2001, she showed various symptoms with a provisional diagnosis of autoimmune disease, hence treatment with chloroquine was provided. In 2003, she showed a single episode of generalised seizure and further diagnosed with systemic lupus erythematosus (SLE). As a result, treatment with prednisolone and chloroquine was provided. In 2011, she had worsening of SLE symptoms and treated with mycophenolate 2g daily. In January 2014 (current presentation), her SLE manifested as lupus panniculitis. The woman’s mycophenolate was discontinued and she started receiving IV pulse cyclophosphamide 500 mg/month for 6 months, following which azathioprine was added. However, her lupus panniculitis was found to be refractory to provided treatments. Finally, her lupus panniculitis responded well to rituximab. Her maintenance therapy included rituximab, deflazacort and hydroxychloroquine. Case 2: The woman at the age of 46 years presented with the complaints of thickening, pain and discoloration of the skin over the right leg for 1 year, which was insidious in onset, gradually progressive, starting from the ankle and ascending in nature involving lower 2/3 rd of her leg. In 1994, she had been diagnosed with central nervous system lupus and received prednisolone 1 mg/kg/day and hydroxychloroquine. In 2011 (current presentation), she had relapse of systemic lupus erythematosus (SLE) and showed symptoms of diffuse proliferative lupus nephritis. She responded to mycophenolate 2g daily. On further examination, her SLE manifested as lupus panniculitis, which was found to be refractory to prednisolone, hydroxychloroquine and mycophenolate. Finally, she responded well to rituximab and continued on the maintenance doses of mycophenolate 2g daily, hydroxychloroquine, prednisolone 5mg daily and rituximab. Gupta P, et al. Refractory lupus panniculitis treated successfully with rituximab: Two cases. Annals of African Medicine 19: 207-210, No. 3, 2020. Available from: URL: 803517817 https://www.annalsafrmed.org/article.asp?issn=1596-3519;year=2020;volume=19;issue=3;spage=207;epage=210;aulast=Gupta

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Reactions 28 Nov 2020 No. 1832