Rowell's Syndrome Triggered by Omeprazole.

Area of Science:

• Dermatology
• Rheumatology
• Immunology

Background:

• Rowell's syndrome is a rare disorder characterized by erythema multiforme (EM)-like lesions in patients with lupus erythematosus.
• Its classification as a distinct entity remains under debate, with some cases potentially drug-induced.

Observation:

• A 67-year-old woman with subacute cutaneous lupus erythematosus (SCLE) presented with EM-like lesions, fulfilling Rowell's syndrome criteria.
• She was on methylprednisolone, hydroxychloroquine, and omeprazole (a proton pump inhibitor) for gastroprotection.
• Lesions were erythematous, annular/target-pattern plaques on sun-exposed areas, with histological findings of lupus and EM.

Findings:

• The patient met major criteria for Rowell's syndrome: lupus erythematosus, EM-like lesions, and speckled antinuclear antibodies (ANA).
• Positive anti-Ro and anti-La antibodies were noted, along with C3 deposits on lesional skin direct immunofluorescence.
• Improvement occurred after increasing hydroxychloroquine, substituting omeprazole with famotidine, and treating a bacterial superinfection.

Implications:

• This case suggests a probable link between proton pump inhibitor (PPI) use and Rowell's syndrome, a rare drug-induced association.
• Rowell's syndrome may represent a distinct entity, separate from coincidental associations between SCLE, drug-induced SCLE, and EM.
• Further research is warranted to elucidate the role of PPIs in the pathogenesis of Rowell's syndrome.