Abstract：
BACKGROUND: Teriflunomide, the active metabolite of leflunomide, is a disease-modifying therapy drug used for the treatment of multiple sclerosis (MS), yet the complications associated with this drug remain not fully understood. Here we present the rare case of a 28-year-old female MS patient who developed subacute cutaneous lupus erythematosus (SCLE) following teriflunomide treatment. Though SCLE has been reported to be associated with leflunomide, the current report represents the first documented evidence demonstrating SCLE as a potential teriflunomide treatment-related complication. Additionally, a literature review on the leflunomide-induced SCLE was conducted to emphasize the association of SCLE with teriflunomide, specifically amongst the female demographic with a preexisting autoimmune diathesis.
METHODS: A 28-year-old female first presented with MS symptoms in the left upper limb along with blurred vision in the left eye. Medical and family histories were unremarkable. The patient exhibited positive serum biomarkers including ANA, Ro/SSA, La/SSB, and Ro-52 antibodies. Relapsing-remitting MS was diagnosed according to the 2017 McDonald\'s diagnostic criteria, and remission was achieved upon intravenous administration of methylprednisolone followed by teriflunomide sequential therapy. Three months post-teriflunomide treatment, the patient developed multiple facial cutaneous lesions. SCLE was subsequently diagnosed and was attributed to treatment-related complication. Interventions include oral administration of hydroxychloroquine and tofacitinib citrate effectively resolved cutaneous lesions. Discontinuation of hydroxychloroquine and tofacitinib citrate treatment led to recurring SCLE symptoms under continuous teriflunomide treatment. Full remission of facial annular plaques was achieved after re-treatment with hydroxychloroquine and tofacitinib citrate. The patient\'s clinical condition remained stable in long-term outpatient follow-ups.
CONCLUSIONS: As teriflunomide has become a standard disease-modifying therapy for MS, the current case report highlights the importance of monitoring treatment-related complications, specifically in relation to SCLE symptoms.
METHODS: A 28-year-old female first presented with MS symptoms in the left upper limb along with blurred vision in the left eye. Medical and family histories were unremarkable. The patient exhibited positive serum biomarkers including ANA, Ro/SSA, La/SSB, and Ro-52 antibodies. Relapsing-remitting MS was diagnosed according to the 2017 McDonald\'s diagnostic criteria, and remission was achieved upon intravenous administration of methylprednisolone followed by teriflunomide sequential therapy. Three months post-teriflunomide treatment, the patient developed multiple facial cutaneous lesions. SCLE was subsequently diagnosed and was attributed to treatment-related complication. Interventions include oral administration of hydroxychloroquine and tofacitinib citrate effectively resolved cutaneous lesions. Discontinuation of hydroxychloroquine and tofacitinib citrate treatment led to recurring SCLE symptoms under continuous teriflunomide treatment. Full remission of facial annular plaques was achieved after re-treatment with hydroxychloroquine and tofacitinib citrate. The patient\'s clinical condition remained stable in long-term outpatient follow-ups.
CONCLUSIONS: As teriflunomide has become a standard disease-modifying therapy for MS, the current case report highlights the importance of monitoring treatment-related complications, specifically in relation to SCLE symptoms.
摘要：
背景：特立氟胺，来氟米特的活性代谢产物，是一种用于治疗多发性硬化症（MS）的疾病改善治疗药物，然而，与这种药物相关的并发症仍未完全了解。在这里，我们介绍了一名28岁女性MS患者的罕见病例，该患者在特立氟胺治疗后发展为亚急性皮肤红斑狼疮（SCLE）。尽管据报道SCLE与来氟米特有关，本报告是第一个有文献记载的证据,证明SCLE是特立氟胺治疗相关的潜在并发症.此外,对来氟米特诱导的SCLE进行了文献综述，以强调SCLE与特立氟米特的相关性，特别是在具有预先存在的自身免疫素质的女性人群中。
方法：一名28岁女性首次出现左上肢MS症状，左眼视力模糊。医疗和家族史并不引人注目。患者表现出阳性的血清生物标志物，包括ANA，Ro/SSA，La/SSB,和Ro-52抗体.根据2017年麦当劳的诊断标准诊断出复发缓解型MS，通过静脉给予甲基强的松龙，然后进行特立氟胺序贯治疗，可以实现缓解。特立氟胺治疗后三个月，患者出现多处面部皮肤病变。随后诊断出SCLE，并归因于治疗相关的并发症。干预措施包括口服羟氯喹和柠檬酸托法替尼，可有效解决皮肤病变。停止羟氯喹和枸橼酸托法替尼治疗导致持续特立氟胺治疗下SCLE症状复发。用羟氯喹和枸橼酸托法替尼再治疗后，面部环状斑块完全缓解。患者的临床情况在长期门诊随访中保持稳定。
结论：由于特立氟胺已成为MS的标准疾病改善疗法，目前的病例报告强调了监测治疗相关并发症的重要性，特别是与SCLE症状有关。
方法：一名28岁女性首次出现左上肢MS症状，左眼视力模糊。医疗和家族史并不引人注目。患者表现出阳性的血清生物标志物，包括ANA，Ro/SSA，La/SSB,和Ro-52抗体.根据2017年麦当劳的诊断标准诊断出复发缓解型MS，通过静脉给予甲基强的松龙，然后进行特立氟胺序贯治疗，可以实现缓解。特立氟胺治疗后三个月，患者出现多处面部皮肤病变。随后诊断出SCLE，并归因于治疗相关的并发症。干预措施包括口服羟氯喹和柠檬酸托法替尼，可有效解决皮肤病变。停止羟氯喹和枸橼酸托法替尼治疗导致持续特立氟胺治疗下SCLE症状复发。用羟氯喹和枸橼酸托法替尼再治疗后，面部环状斑块完全缓解。患者的临床情况在长期门诊随访中保持稳定。
结论：由于特立氟胺已成为MS的标准疾病改善疗法，目前的病例报告强调了监测治疗相关并发症的重要性，特别是与SCLE症状有关。
