Lupus erythematosus is a multisystem disorder that predominantly affects the skin. There are many types of lupus, including systemic lupus erythematosus (SLE), drug-induced lupus erythematosus, neonatal lupus erythematosus, and cutaneous lupus erythematosus. The most common types of cutaneous lupus erythematosus include acute cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus, and chronic cutaneous lupus erythematosus; discoid lupus erythematosus is a subtype of chronic cutaneous lupus erythematosus. Dr James Gilliam described the most commonly used classification of cutaneous lesions in lupus erythematosus. He distinguished lesions as either specific or nonspecific, based on the presence of interface dermatitis on histopathologic examination. Within the category of specific cutaneous lesions, he subdivided these into acute cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus, and chronic cutaneous erythematosus. Discoid lupus erythematosus is the most common subset of chronic cutaneous lupus erythematosus. Patients may or may not report photosensitivity, but lesions are frequently photodistributed and often exhibit secondary atrophy or scarring. Most patients with discoid lupus erythematosus do not have significant systemic disease. Discoid lupus erythematosus can also occur as a manifestation of SLE in approximately 20% of patients. Other less common variants of chronic cutaneous lupus erythematosus include hypertrophic lupus erythematosus, tumid lupus erythematosus, lupus erythematosus panniculitis (also known as lupus profundus), chilblain lupus erythematosus, oral discoid lupus erythematosus, and discoid lupus erythematosus lesions on the palms and soles.

Graves' disease (GD) is the leading cause of autoimmune hyperthyroidism, though pediatric cases are uncommon. Methimazole (MMI) is the first-line therapy; however, drug-induced lupus erythematosus (DILE) secondary to MMI is rare and may be overlooked. We report the case of a 16-year-old girl with newly diagnosed GD who developed inflammatory polyarthritis, a diffuse pruritic maculopapular rash, and alopecia within 1 week of starting MMI (10 mg/day). Laboratory evaluation showed positive antinuclear antibodies and anti-histone antibodies, reduced complement C3 and low-normal C4, and negative anti-double-stranded DNA and extractable nuclear antigen antibodies; urinalysis was normal. MMI was discontinued and oral prednisone (20 mg/day) initiated, resulting in marked improvement within 1 week and complete symptom resolution by days 10-14. This presentation is notable for the unusually rapid onset of MMI-associated DILE in an adolescent and the presence of alopecia, a feature more typical of idiopathic systemic lupus erythematosus (SLE) than classic DILE. The case underscores the importance of maintaining a high index of suspicion for DILE shortly after antithyroid drug initiation, carefully differentiating it from idiopathic SLE using serology and clinical course, and promptly withdrawing the offending agent. Early recognition and short courses of corticosteroids can lead to rapid and complete recovery, while avoiding unnecessary investigations or prolonged morbidity.

Systemic lupus erythematosus (SLE) is a quintessential autoimmune disease once thought to be rare among Africans. Neuropsychiatric manifestations of SLE range from headaches, mood/behavioral disorders, to seizures. There are documented reports of seizures accompanying the diagnosis of SLE, with varying prevalence according to specific regions. However, seizures rarely precede the diagnosis of SLE. We present a case report of a 19-year-old African woman with adult-onset seizures preceding an overt diagnosis of negative anti-dsDNA SLE. A preceding short course of anti-malarial and carbamazepine prompted early consideration of drug-induced lupus erythematosus. However, the clinical features of SLE progressed and persisted despite their discontinuation. Among high-risk groups, it is important to recognize SLE as a potential cause of adult-onset seizures. In the absence of clear offending agents, metabolic or structural disease, baseline antinuclear antibody may be imperative in the diagnostic workup of such patients. Drug-induced lupus (DIL) is an acquired autoimmune condition in which exposure to certain medications leads to lupus-like manifestations. Since the first reports of a lupus-like rash with sulfadiazine exposure in the 1940s, more than 100 drugs have been implicated. Well-established agents include hydralazine, procainamide, isoniazid, minocycline, and quinidine, all of which remain clinically relevant. Patients with DIL typically present with arthralgia, myalgia, fever, and serositis, whereas severe organ involvement is less common than in idiopathic systemic lupus erythematosus (SLE). Symptoms usually resolve with withdrawal of the offending agent, although corticosteroids or antimalarials may be required in persistent cases. More recent pharmacovigilance studies confirm that biologic therapies, particularly tumor necrosis factor-α inhibitors, account for a large proportion of reported cases. In addition, immune checkpoint inhibitors have been associated with both cutaneous and systemic manifestations. Given the diverse array of traditional and emerging drugs associated with DIL, clinicians must maintain awareness across multiple therapeutic classes to ensure timely recognition and management.

BACKGROUND Carbamazepine (CBZ) is a common therapy for seizures, neuropathic pain, and painful tonic spasms following spinal cord disease; however, it is associated with rare autoimmune complications, including drug-induced lupus erythematosus (DILE). Diagnosis of DILE can be challenging, especially when onset occurs after a prolonged latency period. Neuromyelitis optica spectrum disorder (NMOSD), an autoimmune disease characterized by recurrent inflammation of the central nervous system, frequently coexists with other autoimmune disorders. This report describes a case of DILE in a 61-year-old woman with NMOSD involving the cervical and thoracic spinal cord after 14 years of CBZ therapy. CASE REPORT A 61-year-old woman with aquaporin-4-IgG-positive NMOSD involving the cervical and thoracic spinal cords had received CBZ for 14 years to control painful tonic spasms. She presented with fatigue, weight loss, intermittent fever, and pleural effusion. Laboratory testing showed a high antinuclear antibody titer (1: 640) and elevated anti-single-stranded DNA, anti-DNA, and anti-histone antibodies. Chest imaging demonstrated pleural effusion and pleural thickening; malignancy and infection were excluded. Discontinuation of CBZ led to resolution of symptoms, normalization of inflammatory markers, and a decline in lupus-related autoantibodies, confirming the diagnosis of DILE. No recurrence was observed during a 30-month follow-up period. CONCLUSIONS This report describes a rare delayed-onset autoimmune adverse effect of CBZ that developed 14 years after treatment initiation. It highlights the importance of clinical awareness of potential autoimmune associations, particularly when CBZ is used in patients with preexisting autoimmune disorders such as NMOSD.

Immune checkpoint inhibitors (ICIs) are widely used in the treatment of various cancers, but they may lead to multi-system immune-related adverse events (irAEs). Subacute cutaneous lupus erythematosus (SCLE) has rarely been reported, however, it can cause severe adverse cutaneous reactions, which then affect patients' anti-tumor treatment decisions as well as life and survival. This study presented the first case report of SCLE caused by nivolumab in the patient with sigmoid colon cancer, and summarized the clinical manifestations, diagnostic criteria and specific treatment plans of this type of disease. After the treatment of sigmoid colon cancer with nivolumab, a 72-year-old male patient developed multiple well-demarcated erythematous annular plaques on the upper trunk and dorsal forearm, with erythematous borders and central clearing. The infiltrating erythema was observed behind the ear and in the occipital area on both sides, with thin scales attached and gradually increasing. Serum laboratory testing indicated an elevated anti-nuclear antibody (ANA) titer, strong positive for Sjogren's syndrome-A (SS-A)/Ro and Sjogren's syndrome-B (SS-B) antibodies. The pathological result of skin biopsy suggested SCLE. In terms of treatment, the patient's rash was significantly improved after suspending the treatment of nivolumab and adding methylprednisolone and hydroxychloroquine. At present, the patient survived and the rash was stable after seventeen months of follow-up. Through the discussion of this case, the typical characteristics, diagnostic criteria and treatment of DI-SCLE caused by ICIs are summarized in detail, which provides help for early clinical diagnosis and effective management of DI-SCLE caused by ICIs, and effective treatment is expected to prolong the survival period and improve the quality of life of the patients.