Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
National Health Commission Key Laboratory of Diagnosis and Treatment On Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
BMC Neurol. 2023 Apr 26;23(1):168. doi: 10.1186/s12883-023-03146-1.
Teriflunomide, the active metabolite of leflunomide, is a disease-modifying therapy drug used for the treatment of multiple sclerosis (MS), yet the complications associated with this drug remain not fully understood. Here we present the rare case of a 28-year-old female MS patient who developed subacute cutaneous lupus erythematosus (SCLE) following teriflunomide treatment. Though SCLE has been reported to be associated with leflunomide, the current report represents the first documented evidence demonstrating SCLE as a potential teriflunomide treatment-related complication. Additionally, a literature review on the leflunomide-induced SCLE was conducted to emphasize the association of SCLE with teriflunomide, specifically amongst the female demographic with a preexisting autoimmune diathesis.
A 28-year-old female first presented with MS symptoms in the left upper limb along with blurred vision in the left eye. Medical and family histories were unremarkable. The patient exhibited positive serum biomarkers including ANA, Ro/SSA, La/SSB, and Ro-52 antibodies. Relapsing-remitting MS was diagnosed according to the 2017 McDonald's diagnostic criteria, and remission was achieved upon intravenous administration of methylprednisolone followed by teriflunomide sequential therapy. Three months post-teriflunomide treatment, the patient developed multiple facial cutaneous lesions. SCLE was subsequently diagnosed and was attributed to treatment-related complication. Interventions include oral administration of hydroxychloroquine and tofacitinib citrate effectively resolved cutaneous lesions. Discontinuation of hydroxychloroquine and tofacitinib citrate treatment led to recurring SCLE symptoms under continuous teriflunomide treatment. Full remission of facial annular plaques was achieved after re-treatment with hydroxychloroquine and tofacitinib citrate. The patient's clinical condition remained stable in long-term outpatient follow-ups.
As teriflunomide has become a standard disease-modifying therapy for MS, the current case report highlights the importance of monitoring treatment-related complications, specifically in relation to SCLE symptoms.
特立氟胺是来氟米特的活性代谢物，是一种用于治疗多发性硬化症（MS）的疾病修正治疗药物，但该药物相关的并发症仍不完全清楚。在此，我们报告一例 28 岁女性 MS 患者在接受特立氟胺治疗后发生亚急性皮肤型狼疮（SCLE）的罕见病例。虽然 SCLE 已被报道与来氟米特有关，但本报告代表了首例有记录证据表明 SCLE 可能是特立氟胺治疗相关的并发症。此外，还对来氟米特诱导的 SCLE 进行了文献复习，以强调 SCLE 与特立氟胺的关联，特别是在存在自身免疫倾向的女性人群中。
一位 28 岁女性首次出现左上肢 MS 症状，伴有左眼视力模糊。无医疗和家族病史。患者表现出阳性血清生物标志物，包括 ANA、Ro/SSA、La/SSB 和 Ro-52 抗体。根据 2017 年 McDonald 诊断标准诊断为复发缓解型 MS，静脉注射甲基强的松龙后序贯特立氟胺治疗后缓解。特立氟胺治疗 3 个月后，患者出现多处面部皮肤病变。随后诊断为 SCLE，归因于治疗相关的并发症。干预措施包括口服羟氯喹和托法替尼柠檬酸，有效解决了皮肤病变。停用羟氯喹和托法替尼柠檬酸治疗后，在持续特立氟胺治疗下，SCLE 症状再次出现。重新使用羟氯喹和托法替尼柠檬酸治疗后，面部环形斑块完全消退。长期门诊随访中患者病情稳定。
随着特立氟胺已成为 MS 的标准疾病修正治疗药物，本病例报告强调了监测治疗相关并发症的重要性，特别是与 SCLE 症状相关的并发症。
