title: Jessner-Kanof disease induced by leflunomide: a dermal variant of cutaneous lupus?
abstract: Leflunomide can have adverse effects, but cases of subacute cutaneous lupus have more rarely been described. This drug, through its immunomodulatory effect, can favor the appearance of a Th2 lymphocyte immune response inducing lupus. A recent study has suggested that Jessner-Kanof disease (JKD) could be a dermal form of lupus. We report a case of subacute cutaneous lupus induced by leflunomide with anti-Ro/SSA Ab and unusual histological presentation, identical to that of JKD. Leflunomide can induce cutaneous lupus characterized by exclusively dermal involvement and histologically comparable to JKD. This observation therefore suggests that JKD could be a dermal variant of lupus. This prompted a revision of the classification of cutaneous lupus, which has until now been divided into acute, subacute and chronic forms but could equally be classed as epidermal, dermal and hypodermal. The last point of interest in our observation is the efficacy of a combination of chloroquine and anakinra, which led to complete remission of the articular and cutaneous symptoms after the failure of corticotherapy.
authors.affiliation: Rheumatology Department, CHU de Strasbourg, Hôpital de Hautepierre, Avenue Molière, 67098, Strasbourg Cedex, France. lsparsa@hotmail.fr
authors.forename: Laëtitia
authors.initials: L
authors.lastname: Sparsa
authors.forename: Naji
authors.initials: N
authors.lastname: Afif
authors.forename: Joëlle
authors.initials: J
authors.lastname: Goetz
authors.forename: Christelle
authors.initials: C
authors.lastname: Sordet
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chatelus
authors.forename: Dan
authors.initials: D
authors.lastname: Lipsker
authors.forename: Jean
authors.initials: J
authors.lastname: Sibilia
mesh_terms: D000974:Antibodies, Antinuclear / Q000097:blood; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D002738:Chloroquine / Q000627:therapeutic use*; D005260:Female; D006046:Gold / Q000627:therapeutic use; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000627:therapeutic use*; D007555:Isoxazoles / Q000009:adverse effects*; D000077339:Leflunomide; D008178:Lupus Erythematosus, Cutaneous / Q000139:chemically induced* / Q000145:classification / Q000175:diagnosis / Q000473:pathology; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000974:Antibodies, Antinuclear; D018501:Antirheumatic Agents; D053590:Interleukin 1 Receptor Antagonist Protein; D007555:Isoxazoles; D006046:Gold; D002738:Chloroquine; D000077339:Leflunomide; D008727:Methotrexate