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Related Experiment Videos

Rowell's Syndrome Triggered by Omeprazole.

Joana Pozharashka, Lyubomir Dourmishev1, Maria Balabanova

  • 1Lyubomir Dourmishev MD, PhD, Department of Dermatology and Venereology, Medical University - Sofia, Bulgaria, 1st Georgi Sofiiski Blvd,. 1431 Sofia, Bulgaria.

Acta Dermatovenerologica Croatica : ADC
|July 29, 2019
PubMed
Summary
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This case study highlights Rowell's syndrome, a rare condition linking lupus erythematosus with erythema multiforme-like lesions, potentially triggered by proton pump inhibitors (PPIs). Prompt treatment, including PPI discontinuation, led to patient improvement.

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).

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  • 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.