[A new case of Rowell's syndrome].
BACKGROUND
This article introduces a new case of Rowell's syndrome, a controversial entity defined by the association of lupus erythematosus and erythema multiforme.


METHODS
A 43-year-old woman was diagnosed with lupus erythematosus induced by esomeprazole. Because her eruption did not improve after withdrawal of the drug, hydroxychloroquine was administered. Two weeks later, the patient described new annular lesions on her chest and arms, both erosive and crusted, and some had a target-like appearance. The oral mucosa was also affected. Histology revealed sub-epidermal blistering with keratinocytic necrosis, strongly suggesting erythema multiforme. Screening for other causes of erythema multiforme proved negative. A positive outcome was achieved with corticosteroids and hydroxychloroquine. One year later, the patient was in complete remission for both lupus erythematosus and erythema multiforme.


CONCLUSIONS
The association of lupus erythematosus and erythema multiforme first described in 1963 is known as Rowell's syndrome. While diagnostic criteria have been established in the literature, the reality of this entity is still contested. The annular lesions of subacute lupus erythematosus may be confused with the lesions of erythema multiforme. As suggested in the above section, other authors consider Rowell's syndrome to be a singular entity. Indeed, our patient developed lesions distinct from those initially suggesting subacute lupus erythematosus, in particular: the target-like aspect of the elementary lesions, mucosal involvement, a distinct histological aspect, and dissociated outcomes. Ultimately, the definition of Rowell's syndrome remains highly debated.
Clinique dermatologique, faculté de médecine, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France. Electronic address: catherine.schissler@hotmail.fr.
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Schissler
Service de dermatologie, hôpital Pasteur, 39, avenue de la Liberté, 68024 Colmar, France.
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Banea
Service d'anatomie pathologique, hôpital Pasteur, 39, avenue de la Liberté, 68024 Colmar, France.
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Tortel
Service de dermatologie, hôpital Pasteur, 39, avenue de la Liberté, 68024 Colmar, France.
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Mahé
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000897:Anti-Ulcer Agents / Q000009:adverse effects; D002613:Cheilitis / Q000209:etiology; D003937:Diagnosis, Differential; D004892:Erythema Multiforme / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D064098:Esomeprazole / Q000009:adverse effects; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D008178:Lupus Erythematosus, Cutaneous / Q000139:chemically induced / Q000188:drug therapy / Q000473:pathology*; D013577:Syndrome
D000305:Adrenal Cortex Hormones; D000897:Anti-Ulcer Agents; D006886:Hydroxychloroquine; D064098:Esomeprazole
Erythema multiforme; Induced subacute lupus erythematosus; Lupus érythémateux subaigu induit; Rowell's syndrome; Syndrome de Rowell; Érythème polymorphe