Natalizumab
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First report of subacute cutaneous lupus erythematosus: case report A 51-year-old man developed subacute cutaneous lupus erythematosus (SCLE) during treatment with natalizumab for multiple sclerosis. The man, who received second infusion of natalizumab [dosage not stated], presented with a six week history of rash. His symptoms included weight loss and difficulty feeding with the affected hand. His medical history was significant for itchy infiltrative rash (three years prior). At the time of current presentation, he was not receiving any other regular medication. He had well demarcated erythematous annular lesions forming confluent patches over his arms, legs and trunk. Additionally, he was febrile and laboratory investigation showed pancytopenia. A differential diagnosis of cutaneous manifestation of malignancy, drug-mediated immune reaction or erythema multiforme were initially considered. Proteinuria was not detected and common viral aetiologies for erythema were excluded. His skin biopsy showed vacuolar interface dermatitis. The man received treatment with unspecified corticosteroids leading to an improvement in the rash. Thereafter, immunological tests confirmed a positive ANA titer of 1 in 640 along with positive ENA and anti-Ro antibodies and negative dsDNA binding and antiphospholipid antibodies. Based on these findings, he was diagnosed with subacute cutaenous lupus erythematosus with systemic involvement [duration of treatment to reaction onset not stated]. At 2-month follow-up, he had reoccurrence of the SCLE and pancytopenia despite initial improvement. Hence, treatment with corticosteroids was restarted [final outcome not stated] Bolton C, et al. The first case of natalizumab-induced subacute cutaenous lupus erythematosus. Rheumatology 59: 1446-1447, No. 6, Jun 2020. Available from: URL: http:// 803497456 doi.org/10.1093/rheumatology/kez502
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of subacute cutaneous lupus erythematosus associated with natalizumab. The WHO ADR database contained 2 reports of subacute cutaneous lupus erythematosus associated with natalizumab.
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Reactions 22 Aug 2020 No. 1818
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