Alopecia areata and relapsing polychondritis or mosaic autoimmunity? The first experience of co-trimoxazole treatment

Abstract

A 13 year old girl presented with auricular chondritis and recurrent episodes of unexplained chest pain, arthritis, bronchitis, conjunctivitis, prolonged steroid resistant alopecia areata, and a history of recurrent tonsillitis. Both the mosaic of autoimmunity and relapsing polychondritis were considered in the differential diagnosis. The patient was successfully treated with co-trimoxazole. The significance of co-trimoxazole, which is an antibiotic and an immunomodulatory drug, in the treatment of autoimmune disease is discussed.

Figure 1

(A) Diffuse oedema and erythema of the auricle sparing the ear lobe are sustained after five days of intravenous augmentin (amoxycillin+clavulanic acid) treatment (1 g every eight hours). (B) Two days after the initiation of combined treatment with prednisone 40 mg/day and co-trimoxazole 50 mg/kg/day, there is marked diminution of the oedema and erythema.

Figure 2

Monthly values of clinical features and laboratory findings.