A Case of Subacute Cutaneous Lupus Erythematosus in a Patient with Mixed Connective Tissue Disease: Successful Treatment with Plasmapheresis and Rituximab

M. Fantò; S. Salemi; F. Socciarelli; A. Bartolazzi; G. A. Natale; I. Casorelli; A. Pavan; S. Vaglio; R. Di Rosa; R. D'Amelio

doi:10.1155/2013/857694

Case Reports in Rheumatology (Jan 2013)

A Case of Subacute Cutaneous Lupus Erythematosus in a Patient with Mixed Connective Tissue Disease: Successful Treatment with Plasmapheresis and Rituximab

M. Fantò,
S. Salemi,
F. Socciarelli,
A. Bartolazzi,
G. A. Natale,
I. Casorelli,
A. Pavan,
S. Vaglio,
R. Di Rosa,
R. D'Amelio

Affiliations

M. Fantò: Department of Allergy, Clinical Immunology and Rheumatology, S. Andrea Hospital, Sapienza University of Rome, Italy
S. Salemi: Department of Allergy, Clinical Immunology and Rheumatology, S. Andrea Hospital, Sapienza University of Rome, Italy
F. Socciarelli: Department of Pathology, S. Andrea Hospital, Sapienza University of Rome, Italy
A. Bartolazzi: Department of Pathology, S. Andrea Hospital, Sapienza University of Rome, Italy
G. A. Natale: Department of Immunohematology and Transfusion Unit, S. Andrea Hospital, Sapienza University of Rome, Italy
I. Casorelli: Department of Immunohematology and Transfusion Unit, S. Andrea Hospital, Sapienza University of Rome, Italy
A. Pavan: Department of Immunohematology and Transfusion Unit, S. Andrea Hospital, Sapienza University of Rome, Italy
S. Vaglio: Department of Immunohematology and Transfusion Unit, S. Andrea Hospital, Sapienza University of Rome, Italy
R. Di Rosa: Department of Allergy, Clinical Immunology and Rheumatology, S. Andrea Hospital, Sapienza University of Rome, Italy
R. D'Amelio: Department of Allergy, Clinical Immunology and Rheumatology, S. Andrea Hospital, Sapienza University of Rome, Italy

DOI: https://doi.org/10.1155/2013/857694
Journal volume & issue: Vol. 2013

Abstract

Read online

A 30-year-old woman affected by Mixed Connective Tissue Disease with scleroderma spectrum developed a facial eruption, a clinical and histological characteristic of subacute cutaneous lupus erythematosus (SCLE). Speckled anti-nuclear antibodies, high-titer anti-ribonucleoprotein1, anti-Sm, anti-Cardiolipin (aCL) IgG/IgM, and anti-Ro/SSA antibodies were positive. SCLE was resistant to Azathioprine, Hydroxychloroquine, and Methotrexate while Mycophenolate Mofetil was suspended due to side effects. Subsequently, the patient was treated with three cycles of therapeutic plasma exchange (TPE) followed, one month after the last TPE, by the anti-CD20 antibody Rituximab (RTX) (375 mg/m2 weekly for 4 weeks). Eight and 16 months later the patient received other two TPE and RTX cycles, respectively. This therapeutic approach has allowed to obtain a complete skin healing persistent even after 8-month follow-up. Moreover, mitigation of Raynaud's phenomenon, resolution of alopecia, and a decline of aCL IgG/IgM and anti-Ro/SSA antibodies were observed.

Published in Case Reports in Rheumatology

ISSN: 2090-6889 (Print); 2090-6897 (Online)
Publisher: Wiley
Country of publisher: United Kingdom
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the musculoskeletal system
Website: https://onlinelibrary.wiley.com/journal/3857

About the journal