Carbamazepine-induced systemic lupus erythematosus: A case-based review

Abstract

A case of carbamazepine-induced systemic lupus erythematosus (CBZ-DILE) is presented, along witha literature review, with the aim to define the clinical and serological characteristics of this group,and compare them with systemic lupus erythematosus (SLE) triggered by other drugs (DILE). A31-year-old woman presented with a 6-month history of hand arthritis and nasal ulcers. She hadbeen diagnosed with epilepsy at 12 years of age and had continued treatment with carbamazepine(CBZ) for the past 18 years with excellent clinical control. Laboratory data revealed antinuclear an-tibodies (ANA) positive to a titer of 1/1280, and positive anti-nucleosome antibodies. The patients’clinical symptoms disappeared after the CBZ discontinuation and did not reappear during the 1-yearfollow-up period. A search was made in the PubMed/Medline database of the (CBZ-DILE) publishedcases. A total of 26 cases of CBZ-DILE were found in the search. CBZ-DILE cases are characterized byvariable latency periods that often last for years and are not related to the dose of CBZ. Most fre-quent clinical findings of CBZ-DILE in patients are arthralgia/arthritis, mucocutaneous manifestations,constitutional symptoms, and pleuritis or pericarditis. The renal involvement has not been reportedin CBZ-DILE. Antihistone antibodies were observed less frequently, and anti-dsDNA antibodies wereobserved more frequently than in the “classic” DILE. The ANA remained positive in over 60% of casesduring the follow-up after withdrawal. The CBZ-DILE has significant clinical and laboratory manifesta-tions that distinguish it from classic DILE or idiopathic SLE