SHM Converge Scientific Abstract ePoster Gallery-From Arrhythmia to Rash: A Rare Dermatologic Side Effect of Amiodarone

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This case describes a rare example of drug-induced lupus erythematosus (DILE) caused by amiodarone. A 71-year-old woman with atrial fibrillation developed a 3-week history of a diffuse, painful, pruritic erythematous rash with petechiae and mild desquamation, without mucosal involvement. Initial outpatient treatment with topical and low-dose oral steroids provided little relief.<br /><br />During hospitalization, her amiodarone was stopped because of concern for pneumonitis, and she later developed pleuritic chest pain, elevated liver enzymes, and pancytopenia. Autoimmune testing showed a positive ANA and elevated anti-histone antibody, while anti-dsDNA was negative. Skin biopsy demonstrated lichenoid interface dermatitis. Together, these findings raised suspicion for DILE.<br /><br />The report highlights that DILE can present with nonspecific symptoms such as rash, pleurisy, and cytopenias, often weeks to months after exposure to the offending medication, which makes diagnosis challenging. In this patient, amiodarone had been started about six months before symptom onset.<br /><br />Her condition improved significantly after the suspected drug was discontinued and high-dose oral prednisone was started. The case emphasizes the importance of careful medication review in patients with unexplained rashes or multisystem inflammatory findings. Although DILE generally has a favorable prognosis after stopping the causative drug, early recognition can prevent unnecessary testing, prolonged hospitalization, and avoidable interventions.

Asset Subtitle

Katarzyna M. Purzycka

Meta Tag

Author List Hannah Bray, Katarzyna M. Purzycka

Category Clinical Vignettes

Concept Minocycline-Induced Lupus

Concept Drug Discontinuation

Concept ANA

Concept Anti-Histone Antibody

Concept Offending Agent

Distinguished Non-Finalist

Presenter Organization Corewell Health West

Presenting Author Katarzyna M. Purzycka

Track Adult

Keywords

drug-induced lupus erythematosus

amiodarone

rash

anti-histone antibody

ANA positivity

pancytopenia

pleuritic chest pain

lichenoid interface dermatitis

prednisone

medication review

Minocycline-Induced Lupus

Drug Discontinuation

ANA

Anti-Histone Antibody

Offending Agent