Refractory subacute cutaneous lupus erythematosus successfully treated with rituximab.
A 48-year-old woman presented with pruritic, scaly, annular plaques over her upper back and chest that were clinically, serologically and histologically characteristic of subacute cutaneous lupus erythematosus (SCLE). She failed to respond to conventional treatment, which included high-dose hydroxychloroquine, methotrexate, prednisolone, chloroquine, acitretin, thalidomide, dapsone and azathioprine. Subsequently treated with intravenous rituximab 375 mg/m(2) weekly for 4 weeks, she remained on adjuvant oral hydrochloroquine 600 mg daily and topical clobetasol propionate 0.05% ointment as required. Clearing of annular plaques was noted 8 weeks after the initial course of rituximab. By 12 weeks there were no new lesions and only post-inflammatory hyperpigmentation remained. Both hyper- and hypopigmentation, which is more common, are consistent with SCLE lesion regression. Skin lesions recurred 11 months later; however, no further lesions occurred after re-introduction of rituximab therapy. The treatment was well tolerated. A maintenance regimen of rituximab, 375 mg/m(2) every 8 weeks for 2 years, was commenced 3 months after completing the second course of treatment, with ongoing disease remission. Rituximab appears to have activity in refractory SCLE and clinical trials are required to further assess this potential therapy.
Kieu
Violet
V
St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia. violet.kieu@gmail.com
O'Brien
Timothy
T
Yap
Lee-Mei
LM
Baker
Christopher
C
Foley
Peter
P
Mason
Graham
G
Prince
H Miles
HM
McCormack
Christopher
C
D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D001707:Biopsy, Needle; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007155:Immunologic Factors / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008178:Lupus Erythematosus, Cutaneous / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology*; D008875:Middle Aged; D000069283:Rituximab; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab