Open Access Rheumatology: Research and Reviews (Jun 2020)
A Case of Rhupus with Rowell Syndrome
Abstract
Abdulrahman Y Almansouri,1 Zeyad A Alzahrani2 1Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia; 2Division of Rheumatology, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Saudi ArabiaCorrespondence: Abdulrahman Y Almansouri P.O. Box 7194, Jeddah 21462, Saudi ArabiaTel +966 565656486Email [email protected]: We report a case of 30-year-old female who presented initially with hair loss, photosensitive malar rash, morning stiffness and synovitis. She was diagnosed with Rhupus syndrome based on clinical and laboratory findings. Few months after starting hydroxychloroquine, esomeprazole and azathioprine, and failing methotrexate (because of erosive pill-induced esophagitis), she presented with generalized maculopapular dusky reddish rash in her body, back and extremities. Her anti-double stranded-DNA, anti-nuclear antibody, anti-Ro/SSA and anti-La/SSB were positive. Anti-cyclic citrullinated peptide antibody was moderately positive. She had low complements: C3 and C4. Herpes simplex IgM and mycoplasma tested negative. Skin biopsy from right arm showed evidence of erythema multiform. She met the criteria for the diagnosis of Rowell syndrome. We managed her with hydroxychloroquine, prednisolone, mycophenolate mofetil and topical agents and discontinued esomeprazole. We also review the management of Rowell syndrome in the literature.Keywords: Rowell syndrome, systemic lupus erythematosus, erythema multiform, cutaneous lupus erythematosus, rheumatoid arthritis
