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Malar rash caused by metal allergy in a patient with systemic lupus erythematosus

Nature Clinical Practice Rheumatology volume 3, pages 240–245 (2007)Cite this article

An Erratum to this article was published on 01 May 2007

Abstract

Background A 61-year-old woman with an 8-year history of systemic lupus erythematosus presented with a non-pruritic, erythematous, malar rash. Previously, she had tested positive for antinuclear antibody and autoantibodies to double-stranded DNA and Ro/SSA, and had an elevated erythrocyte sedimentation rate. She wore eyeglasses with metal frames and had recently gained weight, which caused the eyeglasses to have increased contact area with her face.

Investigations Physical examination, autoantibody testing, measurement of complement C3 and C4 levels, measurement of erythrocyte sedimentation rate, hypersensitivity patch testing, dimethylglyoxime test of the patient's eyeglass frames.

Diagnosis Delayed-type hypersensitivity reaction to nickel and possibly to cobalt dichloride in the patient's eyeglass frames, which caused a malar rash that mimicked acute cutaneous lupus erythematosus.

Management The rash resolved completely with contact avoidance with the eyeglass frames.

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Figure 1: Photographs of the patient's face
Figure 2: Photographs of delayed-type hypersensitivity test results

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Acknowledgements

Written consent for photography and publication was obtained from the patient described in this Case Study. We thank Marlene Sarmiento, Annie Chan, Frances Reeves, and Lisa Oppel for technical assistance and Dr Sonali Narain for assistance with the anti-Ro/SSA 52 kD antigen assay. This work was supported by research grants R01-AR40391 and M01-R00082 from the US Public Health Service, and State of Florida funding of the Center for Autoimmune Diseases.

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Authors and Affiliations

  1. A Chin-Loy is a first-year Medical Student and R Lyons is a Graduate Student at the Division of Rheumatology & Clinical Immunology; and WH Reeves is Marcia Whitney Schott Professor of Medicine at the Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, M Kosboth is a Postdoctoral Fellow in Rheumatology, University of Florida, Gainesville, FL, USA.,

    Meghavi Kosboth, Anthony Chin-Loy, Robert Lyons, Stanton K Wesson & Westley H Reeves

  2. SK Wesson is Clinical Associate Professor of Dermatology at the Division of Dermatology,

    Meghavi Kosboth, Anthony Chin-Loy, Robert Lyons, Stanton K Wesson & Westley H Reeves

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  1. Meghavi Kosboth
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  2. Anthony Chin-Loy
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Correspondence to Westley H Reeves.

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The authors declare no competing financial interests.

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Kosboth, M., Chin-Loy, A., Lyons, R. et al. Malar rash caused by metal allergy in a patient with systemic lupus erythematosus. Nat Rev Rheumatol 3, 240–245 (2007). https://doi.org/10.1038/ncprheum0464

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