Utilization of Rituximab for Refractory Rowell Syndrome
Rowell syndrome describes the occurrence of erythema multiforme-like lesions in patients with cutaneous lesions of lupus erythematosus. The clinical picture of atypical erythema multiforme-like lesions, presence of chilblains, speckled ANA pattern, anti-Ro/SSA, or anti-La/SSB antibodies, and absence...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Case Reports in Rheumatology |
| Online Access: | http://dx.doi.org/10.1155/2021/2727382 |
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| author | Sukhraj Singh Sandra Sheffield Nisha Chowdhury Swetha Nuthulaganti Zareen Vaghaiwalla Karishma Ramsubeik |
| author_facet | Sukhraj Singh Sandra Sheffield Nisha Chowdhury Swetha Nuthulaganti Zareen Vaghaiwalla Karishma Ramsubeik |
| author_sort | Sukhraj Singh |
| collection | DOAJ |
| description | Rowell syndrome describes the occurrence of erythema multiforme-like lesions in patients with cutaneous lesions of lupus erythematosus. The clinical picture of atypical erythema multiforme-like lesions, presence of chilblains, speckled ANA pattern, anti-Ro/SSA, or anti-La/SSB antibodies, and absence of infectious or pharmacologic triggers in a patient with systemic lupus erythematosus are some of the classic clinical and serologic features. Histopathologic and serologic findings can help differentiate this process from erythema multiforme. We present a case of young woman with systemic lupus erythematosus, end-stage renal disease due to lupus nephritis, and a remote history of Steven–Johnson syndrome due to sulfa allergy who presented to the hospital with a recurrent, progressive, targetoid erythematous rash involving more than 60% of her body surface area. Our patient had several hospitalizations in the recent past for this erythematous rash and had failed oral therapy with prednisone 1 mg/kg and hydroxychloroquine. In view of the minimal improvement and increasing severity and patient exhibiting early features of mast cell activation syndrome, the patient was treated with pulse intravenous glucocorticoids followed by rituximab with an excellent response. We highlight a unique case report of progressive Rowell syndrome refractory to standard of care with an excellent response to rituximab. |
| format | Article |
| id | doaj-art-e7247b9638a94fefa8529fbaf57de062 |
| institution | Kabale University |
| issn | 2090-6889 2090-6897 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Rheumatology |
| spelling | doaj-art-e7247b9638a94fefa8529fbaf57de0622025-02-03T05:47:39ZengWileyCase Reports in Rheumatology2090-68892090-68972021-01-01202110.1155/2021/27273822727382Utilization of Rituximab for Refractory Rowell SyndromeSukhraj Singh0Sandra Sheffield1Nisha Chowdhury2Swetha Nuthulaganti3Zareen Vaghaiwalla4Karishma Ramsubeik5Division of Rheumatology, Department of Medicine, University of Florida Health Jacksonville, Jacksonville, FL, USADivision of Internal Medicine, Department of Medicine, University of Florida Health Jacksonville, Jacksonville, FL, USADivision of Internal Medicine, Department of Medicine, University of Florida Health Jacksonville, Jacksonville, FL, USADivision of Internal Medicine, Department of Medicine, University of Florida Health Jacksonville, Jacksonville, FL, USADivision of Rheumatology, Department of Medicine, University of Florida Health Jacksonville, Jacksonville, FL, USADivision of Rheumatology, Department of Medicine, University of Florida Health Jacksonville, Jacksonville, FL, USARowell syndrome describes the occurrence of erythema multiforme-like lesions in patients with cutaneous lesions of lupus erythematosus. The clinical picture of atypical erythema multiforme-like lesions, presence of chilblains, speckled ANA pattern, anti-Ro/SSA, or anti-La/SSB antibodies, and absence of infectious or pharmacologic triggers in a patient with systemic lupus erythematosus are some of the classic clinical and serologic features. Histopathologic and serologic findings can help differentiate this process from erythema multiforme. We present a case of young woman with systemic lupus erythematosus, end-stage renal disease due to lupus nephritis, and a remote history of Steven–Johnson syndrome due to sulfa allergy who presented to the hospital with a recurrent, progressive, targetoid erythematous rash involving more than 60% of her body surface area. Our patient had several hospitalizations in the recent past for this erythematous rash and had failed oral therapy with prednisone 1 mg/kg and hydroxychloroquine. In view of the minimal improvement and increasing severity and patient exhibiting early features of mast cell activation syndrome, the patient was treated with pulse intravenous glucocorticoids followed by rituximab with an excellent response. We highlight a unique case report of progressive Rowell syndrome refractory to standard of care with an excellent response to rituximab.http://dx.doi.org/10.1155/2021/2727382 |
| spellingShingle | Sukhraj Singh Sandra Sheffield Nisha Chowdhury Swetha Nuthulaganti Zareen Vaghaiwalla Karishma Ramsubeik Utilization of Rituximab for Refractory Rowell Syndrome Case Reports in Rheumatology |
| title | Utilization of Rituximab for Refractory Rowell Syndrome |
| title_full | Utilization of Rituximab for Refractory Rowell Syndrome |
| title_fullStr | Utilization of Rituximab for Refractory Rowell Syndrome |
| title_full_unstemmed | Utilization of Rituximab for Refractory Rowell Syndrome |
| title_short | Utilization of Rituximab for Refractory Rowell Syndrome |
| title_sort | utilization of rituximab for refractory rowell syndrome |
| url | http://dx.doi.org/10.1155/2021/2727382 |
| work_keys_str_mv | AT sukhrajsingh utilizationofrituximabforrefractoryrowellsyndrome AT sandrasheffield utilizationofrituximabforrefractoryrowellsyndrome AT nishachowdhury utilizationofrituximabforrefractoryrowellsyndrome AT swethanuthulaganti utilizationofrituximabforrefractoryrowellsyndrome AT zareenvaghaiwalla utilizationofrituximabforrefractoryrowellsyndrome AT karishmaramsubeik utilizationofrituximabforrefractoryrowellsyndrome |