血管炎ジャーナル

Drug-induced Lupus Syndrome

Abstract

Cuneyt Tetikkurt

DIL is an autoimmune mediated vasculitis against certain drugs. Such drugs may induce autoantibodies in some patients leading to a clinical syndrome similar to systemic lupus erythematosus. Over 100 drugs with mostly hydralazine, procainamide, quinidine, isoniazid, and diltiazem may often cause increased levels of ANA in serum while some patients with these antibodies may develop clinical symptoms of SLE such as rash, serositis, or arthritis suggesting drug-induced disease. Although DIL and SLE share clinical similarities that may lead to a diagnostic dilemma, these two entities have crucial disparities in pathogenetic, immunologic and clinical features. DIL occurs due to the interactions between the drug and DNA or histones that make them immunogenic. DIL is rare but recognition of this syndrome clinically and serologically is crucial because DIL resolves completely within few weeks after withdrawal of the causative agent. Prompt withdrawal is required because continued use may lead to lifethreatening severe cases. This article reviews the pathogenetic mechanisms, clinical manifestations and brings up to date the diagnosis with approach to treatment of DIL.