Malar rash caused by metal allergy in a patient with systemic lupus erythematosus.
BACKGROUND
A 61-year-old woman with an 8-year history of systemic lupus erythematosus presented with a non-pruritic, erythematous, malar rash. Previously, she had tested positive for antinuclear antibody and autoantibodies to double-stranded DNA and Ro/SSA, and had an elevated erythrocyte sedimentation rate. She wore eyeglasses with metal frames and had recently gained weight, which caused the eyeglasses to have increased contact area with her face.


METHODS
Physical examination, autoantibody testing, measurement of complement C3 and C4 levels, measurement of erythrocyte sedimentation rate, hypersensitivity patch testing, dimethylglyoxime test of the patient's eyeglass frames.


METHODS
Delayed-type hypersensitivity reaction to nickel and possibly to cobalt dichloride in the patient's eyeglass frames, which caused a malar rash that mimicked acute cutaneous lupus erythematosus.


RESULTS
The rash resolved completely with contact avoidance with the eyeglass frames.
Kosboth
Meghavi
M
Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610-0221, USA.
Chin-Loy
Anthony
A
Lyons
Robert
R
Wesson
Stanton K
SK
Reeves
Westley H
WH
D000974:Antibodies, Antinuclear / Q000097:blood; D003176:Complement C3 / Q000378:metabolism; D003181:Complement C4 / Q000378:metabolism; D003877:Dermatitis, Contact / Q000175:diagnosis / Q000209:etiology; D005076:Exanthema / Q000175:diagnosis / Q000209:etiology*; D005139:Eyeglasses / Q000009:adverse effects; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000150:complications*; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D009532:Nickel / Q000009:adverse effects
D000974:Antibodies, Antinuclear; D003176:Complement C3; D003181:Complement C4; D008670:Metals; D009532:Nickel