Department of Molecular Genetics and Microbiology, University of New Mexico Health Sciences Center, Albuquerque, USA.
Dallas, USA.
Lupus. 2020 Apr;29(5):509-513. doi: 10.1177/0961203320906265. Epub 2020 Feb 10.
Despite its long history of untoward side effects of a systemic autoimmune disease, drug-induced lupus can be difficult to recognize because of the disconnect between chronic drug usage and onset of symptoms. In this case, the patient was treated with hydralazine for two years when symptoms were initially reported, but a diagnosis of hydralazine-induced lupus was not considered for another half year. Despite treatment with steroidal and nonsteroidal anti-inflammatory medications during this period, rheumatologic symptoms and signs continued to deteriorate, consistent with the diagnosis of systemic lupus erythematosus. Not until the patient voluntarily discontinued hydralazine did symptoms begin to improve, fully resolving over the subsequent 6-12 months largely in the absence of anti-inflammatory medication. This patient demonstrates that failure to recognize a drug-induced disease etiology can result in substantial worsening of rheumatologic symptoms over the subsequent six months, ultimately satisfying criteria for systemic lupus erythematosus. While symptoms and signs largely normalized, some laboratory abnormalities and occasional arthralgia remained two years after discontinuing hydralazine, suggesting smoldering inflammatory disease.
尽管药物性狼疮会引起全身性自身免疫性疾病，且其具有很长的不良反应历史，但由于慢性药物使用与症状发作之间存在脱节，因此这种疾病可能难以识别。在本例中，患者最初出现症状时已使用肼屈嗪治疗两年，但在接下来的半年内并未考虑诊断为肼屈嗪诱导的狼疮。尽管在此期间使用了类固醇和非甾体抗炎药物进行治疗，但风湿症状和体征仍持续恶化，符合系统性红斑狼疮的诊断。直到患者自愿停用肼屈嗪后，症状才开始改善，在随后的 6-12 个月内，在很大程度上没有使用抗炎药物的情况下，症状完全缓解。该患者表明，未能识别药物引起的疾病病因可能导致风湿症状在随后的 6 个月内大幅恶化，最终符合系统性红斑狼疮的标准。虽然症状和体征基本正常，但在停用肼屈嗪两年后，仍存在一些实验室异常和偶尔的关节痛，表明存在慢性炎症性疾病。
