QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Carroll, D. G Articles by Cavanagh, L. E Search for Related Content PubMed PubMed Citation Articles by Carroll, D. G Articles by Cavanagh, L. E

Drug-Induced Lupus Associated with Synthetic Conjugated Estrogens

Clinical Associate Professor, Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Tuscaloosa, AL; Department of Family Medicine, University Medical Center, Tuscaloosa

Lamont E Cavanagh, MD

Assistant Professor, Family Medicine Department, College of Medicine, University of Oklahoma, Tulsa, OK

Reprints: Dr. Carroll, 850 5th Avenue E, PO Box 870374, Tuscaloosa, AL 35487, fax 205/348-2889, dcarroll1{at}cchs.ua.edu

OBJECTIVE: To report a case of drug-induced lupus (DIL) in a patient taking Cenestin, a combination product of synthetic conjugated estrogens.

CASE SUMMARY: A 54-year-old white female presented with a 4 month history of bilateral arm pain that developed and progressively worsened after initiating Cenestin 0.625 mg daily. The patient's symptoms, findings on physical examination (eg, degenerative changes of the acromioclavicular joint), and laboratory test results (eg, antinuclear antibody titer 1–640 [normal <1–40]) were suggestive of DIL. Her symptoms rapidly resolved with discontinuation of Cenestin and promptly resumed with reinitiation of the drug. Laboratory test values also improved significantly with discontinuation of Cenestin. Based on these findings and the Naranjo probability scale score, this reaction was probably associated with Cenestin.

DISCUSSION: DIL differs from systemic lupus erythematosus in that it is caused by prolonged exposure at adequate doses to a drug rather than being an autoimmune reaction. The most commonly reported and studied medications are hydralazine, quinidine, and procainamide. Other medications have been associated with DIL; however, data are limited in these reports, especially with estrogen. There have been no previous reports in the literature of synthetic estrogen products associated with DIL.

CONCLUSIONS: A diagnosis of DIL can be very challenging to make, especially since there are no clear criteria on which to base it. While estrogen has rarely been reported to be associated with DIL, it may be considered as a possible cause.

Key Words: arthralgia, Cenestin, drug-induced lupus

Published Online, March 20, 2007. www.theannals.com, DOI 10.1345/aph.1H478