Isoniazid Induced Lupus Presenting as Oral Mucosal Ulcers with Pancytopenia
Published: October 1, 2016 | DOI: https://doi.org/10.7860/JCDR/2016/22543.8629
RIA SHAH, PADMARAJ ANKALE, KANISHK SINHA, APARNA IYER, T.K JAYALAKSHMI
1. Resident, Department of Pulmonary Medicine, D.Y. Patil Medical College and Hospital, Mumbai, Maharashtra, India.
2. Resident, Department of Pulmonary Medicine, D.Y. Patil Medical College and Hospital, Mumbai, Maharashtra, India.
3. Resident, Department of Pulmonary Medicine, D.Y. Patil Medical College and Hospital, Mumbai, Maharashtra, India.
4. Assistant Professor, Department of Pulmonary Medicine, D.Y. Patil Medical College and Hospital, Mumbai, Maharashtra, India.
5. Professor, Department of Pulmonary Medicine, D.Y. Patil Medical College and Hospital, Mumbai, Maharashtra, India.
Correspondence Address :
Dr. Ria Shah,
52/53/2 Samrat Ashok Society, R.R. Thakkar Marg, Malabar Hill, Mumbai- 400006, Maharashtra, India.
E-mail: drria.s21@gmail.com
Abstract
Drug Induced Lupus Erythematous (DILE) is a rare adverse reaction to a large variety of drugs including Isoniazid (INH), with features resembling idiopathic Systemic Lupus Erythematosus (SLE). Diagnosis require identification of a temporal relationship between drug administered and symptom. It is an idiosyncratic reaction, with no pre-existing lupus. Our case highlights a rare presentation of isoniazid induced lupus with profound pancytopenia and mucosal ulcers, thus posing a diagnostic challenge. The patient was on multidrug treatment for pulmonary and knee joint tuberculosis. DILE was diagnosed on basis of strongly positive Anti Nuclear Antibodies (ANA), anti ds DNA and antihistone antibodies with clinical response to cessation of INH.
Keywords
Anti tubercular treatment, Idiosyncratic reaction, Tuberculosis, Macrophage activation syndrome