A Case of Rhupus with Rowell Syndrome
June 2020
in “
Open access rheumatology
”
hair loss hydroxychloroquine prednisolone mycophenolate mofetil topical agents systemic lupus erythematosus rheumatoid arthritis anti-double stranded-DNA anti-nuclear antibody anti-Ro/SSA anti-La/SSB anti-cyclic citrullinated peptide antibody complement levels C3 C4 erythema multiform Plaquenil Deltasone CellCept topical treatments SLE RA anti-dsDNA ANA anti-Ro anti-La anti-CCP complement proteins EM
TLDR A patient with Rhupus was diagnosed with Rowell syndrome and treated with various medications.
In 2020, a 30-year-old female patient was diagnosed with Rhupus syndrome, a rare overlap of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), after presenting with symptoms including hair loss, a photosensitive malar rash, morning stiffness, and synovitis. Despite initial treatment with hydroxychloroquine, esomeprazole, and azathioprine, and discontinuation of methotrexate due to erosive pill-induced esophagitis, she developed a generalized maculopapular dusky reddish rash. Laboratory tests revealed positive anti-double stranded-DNA, anti-nuclear antibody, anti-Ro/SSA, and anti-La/SSB, with moderately positive anti-cyclic citrullinated peptide antibody and low complement levels (C3 and C4). She tested negative for Herpes simplex IgM and mycoplasma. A skin biopsy indicated erythema multiform, leading to a diagnosis of Rowell syndrome. The patient was treated with hydroxychloroquine, prednisolone, mycophenolate mofetil, topical agents, and esomeprazole was discontinued. The document also reviews the management of Rowell syndrome based on existing literature.
