PDF(Pubmed)
Abstract：
Drug-induced lupus (DIL) usually presents after starting a medication known to induce DIL. However unusual presentations are rare, as such, our patient presented with initial signs and symptoms of pericarditis. Once treated as such, he progressively declined to symptoms of angioedema and worsening cardiopulmonary status. On first admission, the patient presented with chest pain that was worsened by laying down and improved by sitting up. CT Angiography (CTA) showed mild pericardial effusion, and EKG showed diffuse ST elevation, both suggestive of pericarditis, for which the patient was discharged on colchicine. The patient was readmitted one day later with swelling of the neck and tongue. The patient was re-evaluated, tested for autoantibodies, and found a positive antinuclear antibody (ANA) suggesting a diagnosis of lupus, most likely due to hydralazine. We report a rare presentation of drug-induced lupus initially presenting with pericarditis which evolved into worsening angioedema which has not been reported in the literature thus far. Pericarditis and angioedema may be the initial presentation for a patient with drug-induced lupus. Antinuclear and anti-histone antibodies are highly sensitive and specific respectfully for drug-induced lupus. Early diagnosis and time-appropriate discontinuation of the offending agent for patients can be life-saving.
摘要：
药物诱导的狼疮（DIL）通常在开始已知诱导DIL的药物后出现。然而不寻常的演讲很少见，因此，我们的患者出现心包炎的初始体征和症状.一旦这样处理，他逐渐下降到血管性水肿和心肺状态恶化的症状。第一次入场时,患者出现胸痛，躺下加重，坐起来改善。CT血管造影（CTA）显示轻度心包积液，心电图显示弥漫性ST段抬高,都提示心包炎,患者因秋水仙碱而出院。患者在一天后再次入院，颈部和舌头肿胀。患者被重新评估,检测自身抗体,发现抗核抗体（ANA）阳性，提示诊断为狼疮，很可能是因为肼屈嗪.我们报道了一种罕见的药物诱导的狼疮，最初表现为心包炎，演变成恶化的血管性水肿，迄今为止在文献中尚未报道。心包炎和血管性水肿可能是药源性狼疮患者的首发表现。抗核抗体和抗组蛋白抗体对药物诱导的狼疮具有高度敏感性和特异性。对患者进行早期诊断和适当的时间停药可以挽救生命。
