CC BY
3mediterranean journal
of RHEUMATOLOGY
33 1
2022
GChalla M, Baisya R, Devarasetti PK.
This work is licensed under a Creative Commons Attribution 4.0 International L
©CD
CLINICAL IMAGE
Rowell Syndrome with Good Response to Methotrexate
Madhuri Challa, Ritasman Baisya , Phani Kumar Devarasetti
Clinical Immunology & Rheumatology Nizam's Institute of Medical Sciences (NIMS), Hyderabad, India
Mediterr J Rheumatol 2022;33(1):92-3 https://doi.org/10.31138/mjr.33.1.92
Article Submitted: 20 Sep 2021; Revised Form: 31 Jan 2022; Article Accepted: 15 Feb 2022; Available Online: 31 Mar 2022
PRESENTATION
A ten-year-old boy presented to Rheumatology OPD with a short history of polyarthritis, constitutional symptoms, and a generalised rash all over the body. Physical examination revealed well-defined, erythematous papules and plaques, mostly annular with target appearance associated with scales on the face, chest, abdomen. Few of them merged into large, confluent, arcuate lesions. His investigation showed Antinuclear antibody 4 (+) speckled, Anti-Smith antibody, Anti-ribonucleoprotein (RNP) antibody, IgM- Rheumatoid Factor, an-ti-Ro antibody (ELISA) positive. An-ti-dsDNA antibody was negative. His clinical diagnosis fulfilled the 2000 revised diagnostic criteria for Row-ell syndrome by Zeitouni et al.1 After treatment with low dose steroids, hydroxychloroquine, and methotrex-ate, his rashes were improved within a few weeks. (Figures 1 and 2).
Corresponding Author:
Ritasman Baisya
Post DM Senior Resident, Clinical Immunology and Rheumatology Nizam's Institute of Medical Sciences (NIMS), Hyderabad, India E-mail: ritasman91@gmail.com
Figure 1. Extensive erythema multiform-like lesion, with target appearance with lupus erythematous rash over face and anterior aspect of chest.
Figure 2. Healing of lesions after treatment.
92 Cite this article as: Challa M, Baisya R, Devarasetti PK. Rowell Syndrome with Good Response to Methotrexate. Mediterr J Rheumatol 2022;33(1):92-3.
ROWELL SYNDROME WITH GOOD RESPONSE TO METHOTREXATE
DISCUSSION
In 1963, Rowell et al.2 described this syndrome characterised by lupus erythematosus (LE) and erythema multiforme (EM)-like lesions. Subsequently, in 2000, major and minor diagnostic criteria were proposed for the diagnosis of this syndrome by Zeitouni et al.1 Major criteria include coexistence of LE and EM-like lesions, and positive ANA with a speckled pattern. Minor criteria include chilblains, positive anti-La (SS-B) or anti-Ro (SS-A) antibodies, and reactive rheumatoid factor. All the major criteria and at least one of the minor criteria are required to confirm the diagnosis. The present case fulfilled all major and two minor criteria satisfying the diagnosis of Rowell syndrome.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
REFERENCES
1. Zeitouni NC, Funaro D, Cloutier RA, Gagné E, Claveau J. Redefining Rowell's syndrome. Br J Dermatol 2000;142:343-6.
2. Rowell NR, Beck JS, Anderson JR. Lupus erythematosus and erythema multiforme-like lesions. A syndrome with characteristic immunological abnormalities. Arch Dermatol 1963;88:176-80.
