Drug Induced Lupus in Rheumatoid arthritis patient, a case report
Introduction
Systemic lupus erythematosus (SLE) is an auto-immune disorder,
etiology of which to be an interplay between genetic and enviromental
factors acting as activators. These factors could be drugs, sunlight,
pregnancy, viral infection etc. We are reporting a Rheumatoid arthritis
case who developed SLE while receiving antituberculous therapy
(Isoniazid, Rifampicin and Ethambutol) and sulphasalazine.
Case presentation
A 50-year-old Egyptian patient, known to be RA and she was put on
sulphasalazine and hydroxychloroquine, treated with Isoniazide along
with Rifampicin and Ethambutol for suspected pott's disease of spine.
The patient presented with pleural and pericardial effusion after initiation
of this therapy without any prior evidence of pulmonary tuberculosis
involvement. Follow up testing including thoracoscopic pleural fluid
aspiration for analysis never confirmed tuberculosis infection.
Further evaluation yielded serological evidence suggesting drug-induced
lupus.
No effusion recurrence after discontinuation of Isoniazid and minipulse
steroid with methyprednisolone, although other antituberculous
medications were continued.
Conclusion
Drug induced lupus may explain at least some cases of new pleural and
pericardial effusion following the initiation of Isoniazid or
sulphasalazine in RA patient.