Systemic lupus erythematosus penicillamine

Colitis, concurrent use of antimalarials, immunosuppressive agents, penicillamine, or phenylbutazone, congestive heart failure (CHF), exfoliative dermatitis, history of blood dyscrasias, severe liver or renal impairment, systemic lupus erythematosus... 

A rash or photosensitivity can also occur as part of the penicillamine-induced lupus-like syndrome (248-250). Type II bullous systemic lupus erythematosus (251) and necrotizing vasculitis (46) have been attributed to penicillamine. In one report, a hypersensitivity reaction to penicillamine with a skin rash and fever was associated with low back pain (252). 

Joint symptoms in patients taking penicillamine vary from creaking and subjective discomfort and worsening of joint pain to severe arthralgia (327-329). Paradoxical acute severe exacerbation of rheumatoid arthritis has been reported in three patients, probably induced by penicillamine (330). Arthritis can also be a manifestation of peniciUamme-mduced systemic lupus erythematosus. 

Rejchrt S, Hrncir Z, Pinterova E. [Rheumatoid arthritis developing into systemic lupus erythematosus during longterm treatment with penicillamine and sulfasalazine.) Vnitr Lek 1991 37(6) 597-603. 

Condon C, Phelan M, Lyons JF. Penicillamine-induced type II bullous systemic lupus erythematosus. Br J Dermatol 1997 136(3) 474-5. 

Chahners A, Thompson D, Stein HE, Reid G, Patterson AC. Systemic lupus erythematosus during penicillamine therapy for rheumatoid arthritis. Ann Intern Med 1982 97(5) 659-63. 

A drug-induced systemic lupus erythematosus (SEE) with proliferative glomerulonephritis has also been described in patients treated with D-penicillamine [111, 157]. Systemic lupus erythematosus syndrome is induced in approximately 2% of patients treated with D-penicillamine [112,158]. Unlike other forms of drug-induced systemic lupus erythematosus, anti-double-strand DNA anhbodies and/or hypocomplementemia are seen in D-penicillamine-induced systemic lupus erythematosus syndrome [111, 156]. Nephropathy is rare in D-penicillamine-induced systemic lupus erythematosus syndrome [111]. Walshe [112] reported that 8 patients developed the serological change of systemic lupus erythematosus of 120 patients with Wilson s disease treated with D-penicillamine, but none of them showed nephropathy. 

Chalmers [111] reported 6 rheumatoid arthritis patients with D-penicillamine-induced systemic lupus erythematosus syndrome. All patients had previous... 

In addition to penicillamine nephropathy, other side effects of the drug may be related to the widespread deposition of immune complexes (Figure 3). Dense, granular immunoglobuhn deposits have been identified at the epidermodermal junction in 4 rheumatoid arthritis patients who developed toxic reactions, such as severe rashes, thrombocytopenia, aplastic anemia, and proteinuria. Three of 4 penicillamine-induced systemic lupus erythematosus syndrome patients had similar findings on skin biopsy [161]. 

The antirheumatic action of D-penicillamine initially had limited application. However, in the early 1970s controlled trials have established the drug s intrinsic activity. There are many similarities to chrysotherapy both in clinical response (lowering of rheumatoid factor serum titer, decreased inflammatory response) and adverse effects (glomerulonephritis). However, some are potentially very serious, particularly aplastic anemia and systemic lupus erythematosus (SLE). The most important hint as to the uncertain mechanism of penicillamine s disease-suppressive properties is probably the considerable decrease in IgM (rheumatoid factor) levels. 

Tsankov NK, Lazarova AZ, Vasileva SG, Obreshkova EV. Lupus erythematosus-like eruption due to D-penicillamine in progressive systemic sclerosis. Int J Dermatol 1990 29(8) 571-4. 

Drug-induced lupus erythematosus has previously been reported to be associated with Wilson disease as a complication of treatment with D-penicillamine. A case study of a young girl who, at age 5, was diagnosed with Wilson disease and was treated with D-penicillamine developed proteinuria Syears after beginning treatment [74 ]. Zinc acetate was substituted for D-penicillamine and naproxen was started for arthritis. Instead, idiopathic systemic lupus erythmatosus was diagnosed, the first reported association between Wilson disease and this version of lupus. 

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