Table 2.
Investigations, therapeutic and clinical profile of patients
| Age/sex | Investigations | ANA (IF/ELISA)/ANA profile | Skin biopsy (H and E/DIF) | Treatment | Outcome | Relapse (if any) | Naranjo score |
|---|---|---|---|---|---|---|---|
| 70/F | ESR- 115 mm/1st hr Mild proteinuria | ANA (IF)- 1:320 Anti-Ro/SSA++Anti-La/SSB +/− |
Hyperkeratosis, epidermal atrophy, vacuolar degeneration of DEJ, necrotic keratinocytes, dense collection of neutrophils and lymphocytes in papillary dermis consistent with SCLE DIF- negative | DW + SCS | CR | + (On re-exposure to P) | Definite |
| 60/F | WNL | ANA (ELISA) +++ Anti-Ro/SSA ++ |
Hyperkeratosis, parakeratosis, irregular acanthosis, spongiosis, intraepidermal bulla, vacuolar degeneration of basal layer with increased dermal collagenization, few necrotic keratinocytes with perivascular lymphocytic infiltrate- reported as EM-like | DW + TCS + SCS | CR | - | Probable |
| 55/M | WNL | ANA (ELISA) +++ Anti-Ro/SSA++Anti-La/SSB ++ |
Epidermal atrophy, basal cell vacuolization, mild perivascular lymphocytic infiltrate- SCLE | SCS + HCQS | PR | LTF | Probable |
| 62/F | WNL | ANA (ELISA) ++ Anti-Ro/SSA ++ | Hyperkeratosis, epidermal atrophy, basal cell vacuolization, perivascular lymphocytic infiltrate, thickened basement membrane, and myxoid degeneration- SCLE | DW + SCS | CR | - | Probable |
| 62/M | WNL | ANA (ELISA) +++ Anti-Ro/SSA++Anti-La/SSB++ |
Basal cell vacuolization, dermal edema, mucin deposition, chronic perivascular infiltrate- SCLE | DW + SCS | CR | + (On re-exposure to E) | Definite |
| 53/M | Thrombocytopenia (13,000 mL/dL) | ANA (IF)- 1:80 Anti-Ro/SSA ++ |
Hyperkeratosis, perivascular and periadnexal lymphocytic infiltrate, basal cell vacuolization- SCLE
DIF- negative |
DW + SCS | CR | - | Probable |
| 60/M | WNL | ANA (ELISA) +++ Anti-Ro/SSA++Anti-La/SSB ++ |
Hyperkeratosis, epidermal atrophy, basal cell vacuolization, perivascular chronic inflammatory infiltrate- SCLE
>DIF- negative |
DW + SCS | CR | - | Probable |
ANA=Antinuclear antibody, CR=Clinical remission, DEJ=Dermo-epidermal junction, DIF=Direct immunofluorescence, DW=Drug withdrawal, E=Esomeprazole, ELISA=Enzyme-linked immunosorbent assay, EM=erythema multiforme, H and E=Hemotoxylin and eosin, IF=Immunofluorescence, LTF=Lost to follow-up, P=Pantoprazole, PR=Partial remission, SCLE=Subcutaneous lupus erythematosus, SCS=Systemic corticosteroids, TCS=Topical corticosteroids, WNL=within normal limit