Gantzer A, Regnier S, Cosnes A, Ortonne N, Wolkenstein P, Bagot M, Duong T-A
Service de dermatologie, hôpital Henri-Mondor, AP-HP, faculté Paris-12, 51 avenue du Maréchal-de-Lattre de Tassigny, Créteil, France.
Ann Dermatol Venereol. 2011 May;138(5):409-17. doi: 10.1016/j.annder.2011.02.015. Epub 2011 Apr 17.
Subacute cutaneous lupus erythematosus is an uncommon dermatosis characterised by a non-scarring, annular photo-distributed dermatosis associated with anti-Ro/SSA antibodies. It is remarkable as a paraneoplastic syndrome (12 cases in the literature). We report two cases of subacute cutaneous lupus erythematosus occurring in patients treated for metastatic breast adenocarcinoma.
Case 1: a 72-year-old woman with breast carcinoma relapsing after surgery, chemotherapy, hormone therapy, and without treatment for 6 months, was admitted for an acute erythematous slightly squamous and photo-distributed eruption. On clinical examination, she was found to be presenting polyadenopathy and pleural effusion. Case 2: a 46-year-old woman with a history of breast carcinoma was admitted for an erythematopapular, annular and photo-distributed eruption occurring after a second breast cancer relapse and five months after initiation of docetaxel. A new line of chemotherapy initially resulted in regression of the lesions, and progression of the breast cancer was associated with cutaneous relapse.
The diagnosis of subacute cutaneous lupus erythematosus was supported in our two patients by the presence of an annular photo-distributed eruption associated with positive testing for anti-Ro/SSA antibodies. Occurrence of the eruption in both cases with relapse of the neoplasia and its improvement after oncological treatment reinforced the diagnosis of paraneoplastic syndrome in one case, and the use of chemotherapy known to trigger lupus could have suggested a diagnosis of drug-induced subacute cutaneous lupus erythematosus. Thus, the association between lupus and cancer is relevant.
亚急性皮肤型红斑狼疮是一种罕见的皮肤病，其特征为非瘢痕性、环状、光分布性皮疹，并与抗Ro/SSA抗体相关。作为一种副肿瘤综合征，它很引人注目（文献中有12例报道）。我们报告了两例在接受转移性乳腺腺癌治疗的患者中发生的亚急性皮肤型红斑狼疮病例。
病例1：一名72岁女性，乳腺癌术后复发，接受过化疗、激素治疗，且6个月未接受治疗，因急性红斑、轻度鳞屑性、光分布性皮疹入院。临床检查发现她有多处淋巴结肿大和胸腔积液。病例2：一名46岁女性，有乳腺癌病史，因在第二次乳腺癌复发后及多西他赛治疗5个月后出现红斑丘疹性、环状、光分布性皮疹入院。新的化疗方案最初使皮损消退，而乳腺癌进展与皮肤复发相关。
我们的两名患者中，亚急性皮肤型红斑狼疮的诊断依据是存在环状、光分布性皮疹以及抗Ro/SSA抗体检测呈阳性。两例皮疹均在肿瘤复发时出现，且在肿瘤治疗后改善，这在一例中强化了副肿瘤综合征的诊断，而使用已知可引发狼疮的化疗药物可能提示药物性亚急性皮肤型红斑狼疮的诊断。因此，狼疮与癌症之间的关联值得关注。
