title: A case of subacute cutaneous lupus erythematosus in a patient with mixed connective tissue disease: successful treatment with plasmapheresis and rituximab.
abstract: A 30-year-old woman affected by Mixed Connective Tissue Disease with scleroderma spectrum developed a facial eruption, a clinical and histological characteristic of subacute cutaneous lupus erythematosus (SCLE). Speckled anti-nuclear antibodies, high-titer anti-ribonucleoprotein1, anti-Sm, anti-Cardiolipin (aCL) IgG/IgM, and anti-Ro/SSA antibodies were positive. SCLE was resistant to Azathioprine, Hydroxychloroquine, and Methotrexate while Mycophenolate Mofetil was suspended due to side effects. Subsequently, the patient was treated with three cycles of therapeutic plasma exchange (TPE) followed, one month after the last TPE, by the anti-CD20 antibody Rituximab (RTX) (375 mg/m(2) weekly for 4 weeks). Eight and 16 months later the patient received other two TPE and RTX cycles, respectively. This therapeutic approach has allowed to obtain a complete skin healing persistent even after 8-month follow-up. Moreover, mitigation of Raynaud's phenomenon, resolution of alopecia, and a decline of aCL IgG/IgM and anti-Ro/SSA antibodies were observed.
authors: Department of Allergy, Clinical Immunology and Rheumatology, S. Andrea Hospital, Sapienza University of Rome, Italy.
authors: M
authors: M
authors: Fantò
authors: S
authors: S
authors: Salemi
authors: F
authors: F
authors: Socciarelli
authors: A
authors: A
authors: Bartolazzi
authors: G A
authors: GA
authors: Natale
authors: I
authors: I
authors: Casorelli
authors: A
authors: A
authors: Pavan
authors: S
authors: S
authors: Vaglio
authors: R
authors: R
authors: Di Rosa
authors: R
authors: R
authors: D'Amelio
references: Best Pract Res Clin Rheumatol. 2012 Feb;26(1):61-72
references: 22424193
references: Intern Med. 2000 Dec;39(12):1119-22
references: 11197805
references: Dermatology. 2000;200(1):6-10
references: 10681606
references: Lupus. 2009 Aug;18(9):767-76
references: 19578100
references: Rheumatol Int. 2013 Jun;33(6):1495-504
references: 23239037
references: Br J Dermatol. 2011 Mar;164(3):465-72
references: 21039412
references: Rheumatology (Oxford). 2007 Apr;46(4):718-9
references: 17289791
references: Clin Exp Rheumatol. 2012 Mar-Apr;30(2 Suppl 71):S17-22
references: 22244622
references: Australas J Dermatol. 2009 Aug;50(3):202-6
references: 19659984
references: Br J Dermatol. 1998 Jun;138(6):1039-42
references: 9747370
references: Rheumatology (Oxford). 2007 Oct;46(10):1628-9
references: 17766999
references: J Invest Dermatol. 1992 Sep;99(3):251-7
references: 1512459
references: Aust N Z J Med. 1987 Jun;17(3):327-9
references: 3675385
references: J Rheumatol. 2013 Jan;40(1):52-7
references: 23118116
references: Rheumatology (Oxford). 2006 Apr;45(4):490-1
references: 16461439