engleski

Discoid lupus erythematosus overlapping with toxic epidermal necrolysis:a case report

Discoid lupus erythematosus (DLE) is a chronic cutaneous form of lupus erythematosus, characterized by inflammation and scarring skin lesions, epidermal basal-layer abnormalities and lymphocyte infiltration in the perivascular and periappendageal areas. Toxic epidermal necrolysis (TEN) is an acute, life-threatening disease, almost always drug related. We report a patient with diagnosis of DLE, confirmed by histological features, who developed drug related TEN. Direct immunofluorescence of skin showed no deposits of immunoglobulins and complement. Anti-nuclear antibodies (ANA) were negative with IIF on HEp-2 cells, however anti-Ro/SSA positivity was confirmed with ELISA. Patient was treated with chloroquine for three years with good improvement of skin lesions and was followed-up regularly. Patient was in complete remission except skin fragility on photoexposed areas, and cicatricial white patches and teleangiectasia on the face. After 5 years he developed erythematous keratotic patches on the face and hands and chloroquine was reintroduced. At that time patient started to take analgetics for chronic back pain. Three weeks later, progressive erythema and oedema developed on the face and the whole body followed by lamellar desquamation and erosions. Diagnosis of TEN was confirmed on biopsy. Skin swabs were positive for Staph. aureus. All medication was discontinued and systemic treatment included support measures, antibiotics and topical bethamethason dipropionate ointment. Skin completely recovered after eight weeks. The lymphocyte transformation test (TTL) showed positivity to tramadol and paracetamol fixed combination. Chloroquine was restarted with complete remission of skin lesions except for scars and teleangiectasia.

discoid lupus erythematosus; toxic epidermal necrolysis; immunofluorescence

nije evidentirano