Almansouri Abdulrahman Y, Alzahrani Zeyad A
Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia.
Division of Rheumatology, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia.
Open Access Rheumatol. 2020 Jun 9;12:91-96. doi: 10.2147/OARRR.S255790. eCollection 2020.
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.
我们报告一例30岁女性患者，最初表现为脱发、光敏性颧部皮疹、晨僵和滑膜炎。根据临床和实验室检查结果，她被诊断为Rhupus综合征。在开始使用羟氯喹、埃索美拉唑和硫唑嘌呤治疗且甲氨蝶呤治疗失败（因糜烂性药丸性食管炎）数月后，她在身体、背部和四肢出现泛发性斑丘疹性暗红色皮疹。她的抗双链DNA、抗核抗体、抗Ro/SSA和抗La/SSB均呈阳性。抗环瓜氨酸肽抗体呈中度阳性。她的补体水平较低：C3和C4。单纯疱疹IgM和支原体检测均为阴性。右臂皮肤活检显示有多形红斑的证据。她符合罗威尔综合征的诊断标准。我们用羟氯喹、泼尼松龙、霉酚酸酯和局部用药对她进行治疗，并停用了埃索美拉唑。我们还回顾了文献中罗威尔综合征的治疗方法。
