Hydroxychloroquine-induced generalized myopathy in a patient with lupus tumidus: a case report

Abstract

A subtype of cutaneous lupus erythematosus known as lupus erythematosus tumidus (LET) is characterized by sun-exposed areas that typically display urticaria-like papules and plaques. For LET, systemic therapy with antimalarials - particularly hydroxychloroquine (HCQ) - is the first line of treatment. Even though the safety profile of these medications appears to be high, there have been very few reports of side effects in the literature, including hemolytic anemia, retinal toxicity, maculopapular rash, gastrointestinal disturbance, and blue-gray discoloration of the skin or mucous membranes. Here, we report a unique instance of a 46-year-old LET smoker who, following HCQ treatment, developed a generalized myopathy.

Keywords: cutaneous lupus erythematosus; drug reaction; hydrox-ychloroquine-induced myopathy; lupus tumidus; tacrolimus ointment.

Figure 1.

A-C) Erythematous infiltrated annular plaques with pasty consistency, involving the face, neck, and upper part of the trunk; D) resolution of skin lesions after calcineurin inhibitors (0.1% tacrolimus ointment) topical treatment.

Figure 2.

A,B) Trunk lesion showed vacuolar degeneration of the basal layer of keratinocytes, and perivascular and periannexial lymphohistiocytic infiltrate in the in the superficial and deep dermis. A) Hematoxylin-eosin; original magnification, 5x; B) mucin deposits in the dermis (Alcian blue staining, 20x).