Review Question - QID 109182

Action	Numeric Key	Letter Key	Function Key
Choose 1	1
Choose 2	2
Choose 3	3
Choose 4	4
Choose 5	5
Submit Response			Enter
Previous Question			Left Arrow
Next Question		N	Right Arrow
Open/Close Bookmode		C
Open Image			Spacebar

Systemic Lupus Erythematous ETIOLOGY Pathogenesis QID: 109182 (M2.RH.17.4799)

QID 109182 (Type "109182" in App Search)

A 38-year-old woman comes to clinic complaining of general malaise and a facial rash. She reports that the rash began one week ago after she had been playing outside with her dog. The rash has not resolved nor improved since then. She denies pain or pruritus. When asked about new exposures, the patient denies any changes in lotions or soaps, but does report she was recently prescribed a new medication by her primary care physician. The patient denies tobacco or illicit drug use. She is sexually active with one male partner. She works as a school nurse in an elementary school, and she recently traveled to Botswana for two months for a missionary trip. The patient’s temperature is 99°F (37.2°C), blood pressure is 112/72 mmHg, pulse is 74/min, and respirations are 14/min with an oxygen saturation of 99% O2 on room air. On physical exam, you appreciate an oral ulcer, and mild joint stiffness and swelling of the patient’s hands and knees. A photograph of the patient’s facial rash is shown in Figure A. You feel her current presentation is drug-related. Which of the following could be the medication causing her symptoms?

Type & Select Correct Answer

Type in at least one full word to see suggestions list

Amiodarone

0/37

Carbamezapine

0/37

Doxycycline

22%

8/37

Hydralazine

70%

26/37

Methotrexate

2/37

Select Answer to see Preferred Response

Review TC In New Tab

This patient is presenting with malaise, a malar rash, and joint swelling that occurred following a recent drug exposure suggesting a diagnosis of drug-induced lupus. Hydralazine can precipitate drug-induced lupus.

Drug-induced lupus is an autoimmune response following exposure to certain medications, which induces the production of autoantibodies. Common drugs that cause drug-induced lupus include quinidine, chlorpromazine, hydralazine, isoniazid, methyldopa, primaquine, penicillamine, and procainamide (mnemonic: Cute CHIMPPP). Patients with drug-induced lupus can develop a variety of systemic signs and symptoms resembling spontaneous lupus including fever, myalgias, rash, oral ulcers, arthralgias/arthritis, and serositis. Anti-histone antibodies are typically found in drug-induced lupus.

Figure A shows a malar rash, which is characteristically red, mildly scaly, and spares the nasolabial folds.

Incorrect Answers:
Answer 1: Amiodarone can cause bluish pigmentation of the skin and photosensitivity (though less commonly). It can also cause hypothyroidism, peripheral neuropathy, pulmonary fibrosis, hepatotoxicity, and ocular symptoms.

Answer 2: Carbamezapine can cause Stevens-Johnson syndrome (SJS). This is a severe, febrile desquamating/blistering disease of the skin, and always involves mucus membranes (e.g., ocular, oral, genital, and anal).

Answer 3: Doxycycline can cause photosensitivity. Other adverse reactions include gastrointestinal distress.

Answer 5: Methotrexate can cause photosensitivity as well as other oral and gastrointestinal mucosal symptoms (e.g., glossitis, entertitis, and mouth/gut ulcerations). Additional adverse effects include myelosuppression, hepatotoxicity, and pulmonary fibrosis.

Bullet Summary:
Drug-induce lupus can present with the classic symptoms of lupus following exposure to common causative agents, such as quinidine, chlorpromazine, hydralazine, isoniazid, methyldopa, primaquine, penicillamine, or procainamide.

Rating

Please Rate Question Quality

4.1

(10)