Antinuclear antibody-negative, drug-induced lupus caused by lisinopril.
The clinical symptoms of drug-induced lupus (DIL) are similar to those of idiopathic systemic lupus erythematosus. The literature indicates that in patients with DIL, sera generally contain antinuclear antibodies (ANAs); however, ANA-negative DIL has been reported. The list of medications implicated as etiologic agents in DIL continues to grow. This list includes two different types of angiotensin-converting enzyme inhibitors--captopril and enalapril. We report the first case of DIL caused by lisinopril. Our patient had negative results on ANA testing and had histone antibodies (IgG anti-[H2A-H2B]-DNA) mirroring the disease course. Antibodies to the (H2A-H2B)-DNA complex are seen in more than 90% of patients with active DIL, excluding those with DIL due to hydralazine. Thus, it is important to recognize the clinical significance of IgG anti-(H2A-H2B)-DNA antibodies and that negative ANA test results do not preclude the diagnosis of DIL.
Carter
J D
JD
Department of Internal Medicine, University of South Florida College of Medicine, Tampa 33612, USA.
Valeriano-Marcet
J
J
Kanik
K S
KS
Vasey
F B
FB
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D000888:Antibodies, Anti-Idiotypic / Q000097:blood; D000974:Antibodies, Antinuclear / Q000097:blood*; D005260:Female; D006657:Histones / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000188:drug therapy*; D017706:Lisinopril / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D008177:Lupus Vulgaris / Q000097:blood* / Q000139:chemically induced*
D000806:Angiotensin-Converting Enzyme Inhibitors; D000888:Antibodies, Anti-Idiotypic; D000974:Antibodies, Antinuclear; D006657:Histones; C048844:anti-IgG; D017706:Lisinopril