Dexlansoprazole-Induced Subacute Cutaneous Lupus Erythematosus (SCLE)

This is the authors' abstract. We don't add key points for this paper.

Drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) was first described in 1985 in patients taking hydrochlorothiazide. Since then, there have been many reports of DI-SCLE. One of the newer drug classes reported to be associated with DI-SCLE is proton pump inhibitors (PPI). In 2014, Sandholdt et al reported 24 episodes of PPI-induced SCLE in a case series. We present another case of SCLE induced by a PPI that is the first case of Dexlansoprazole-induced SCLE. Our patient is a 52 year old Caucasian male with a history of long standing reflux unresponsive to Nexium and Prilosec. He took Dexlansoprazole 60mg daily which worked very well for his reflux symptoms. He did not start any other new medications. A week later, he developed a rash which started with one lesion on the left upper arm that progressed to multiple non-pruritic spots on the trunk and arms and later to his face, neck, chest, back, abdomen, shoulders and dorsal forearms. The rash consisted of scattered round erythematous plaques, some of which were annular with central peeling/necrotic areas, and a trailing scale on many lesions. Otherwise he was asymptomatic with no systemic symptoms. A punch biopsy showed vacuolar interface dermatitis, consistent with a diagnosis of SCLE. His blood work revealed Anti-SS-A/Ro and Anti-SS-B/La positivity, negative ds DNA antibodies, normal C3 and C4 complement levels and his ANA was only 1:80 positive. Dexlansoprazole was stopped and he required Prednisone, Plaquenil and MTX before his symptoms subsided. Drug-induced Lupus erythematosus (DILE) is a lupus-like syndrome related to drugs that is temporary, resolves with discontinuation of the provoking drug and returns with the drug's reintroduction. The most common type of DILE is SCLE which is generally milder, but otherwise, histopathologically and immunologically similar to idiopathic SCLE with mainly dermatological manifestations. Unlike idiopathic SCLE, DI-SCLE rarely has systemic involvement and presents with non-scarring annular or papulosquamous eruptions on sun-exposed skin. Serology testing in DI-SCLE usually reveals the presence of anti-Ro/SSA, and often anti-La/SSb, ANA and rarely anti-histone antibodies. Its pathology remains largely unclear.Figure 1Figure 2Figure 3DI-SCLE has been reportted with many drugs, including some PPIs, but this is the first time it is being seen with Dexlansoprazole. Our patient will not be a candidate for PPI usage in the treatment of reflux given the risks of rechallenge.