Subacute cutaneous lupus erythematosus associated with radioiodine treatment

Cutaneous drug-induced lupus erythematosus: Clinical and immunological characteristics and update on new associated drugs

Cutaneous drug-induced lupus erythematosus (CDILE) is a lupus-like syndrome related to drug exposure which typically resolves after drug discontinuation. It can present as a systemic or a sole cutaneous form and different drugs may be associated with each form. CDILE pharmacoepidemiology is constantly changing. Indeed, older drugs primarily associated with systemic CDILE are no longer prescribed and new drugs associated with either cutaneous or systemic CDILE have emerged. The present study discusses the clinical and laboratory aspects of CDILE and the postulated pathogenesis, and it provides an update on implicated drugs. We performed a literature review to single out the new drugs associated with CDILE in the past decade (January 2010-June 2020). Among 109 drugs reported to induce CDILE in 472 patients, we identified anti-TNFα, proton-pump inhibitors, antineoplastic drugs, and, in particular, checkpoint inhibitors, as emerging drugs in CDILE. Most of the published studies are cases reports or small case series, and further larger studies as well as the development of validated classification criteria are needed to better understand and characterize their implication in CDILE.

Risk Factors of 131I-Induced Salivary Gland Damage in Thyroid Cancer Patients

CONTEXT

Sialadenitis and xerostomia are major adverse effects of ¹³¹I therapy in thyroid cancer patients. The risk factors for these adverse effects, other than administered activity of ¹³¹I, have not been investigated.

OBJECTIVE

The aim of this study is to identify risk factors for ¹³¹I-induced salivary gland damage among follicular cell-derived thyroid cancer patients.

DESIGN

We enrolled 216 thyroid cancer patients who visited The Ohio State University Wexner Medical Center between April 2013 and April 2014. Symptoms of xerostomia and sialadenitis were identified via questionnaire and medical record search. To validate the findings in a large cohort, we retrospectively searched for ICD-9/10 codes for sialadenitis, xerostomia, and autoimmune disease associated with Sjögren's syndrome (AID-SS) in our existing database (n = 1507). Demographic and clinical information was extracted from medical records. Multivariate analyses were performed to identify independent predictors for salivary gland damage.

RESULTS

¹³¹I treatment associated with higher incidence of xerostomia and sialadenitis. Patients with xerostomia had 46 mCi higher mean cumulative ¹³¹I activity and 21 mCi higher mean first-administered ¹³¹I activity than patients without xerostomia. Increased age associated with higher incidence of xerostomia, and females had a higher incidence of sialadenitis. Patients who experienced sialadenitis before ¹³¹I therapy had higher sialadenitis incidence after ¹³¹I therapy. ¹³¹I-treated patients diagnosed with AID-SS, whether before or after ¹³¹I treatment, had a higher incidence of xerostomia and sialadenitis among ¹³¹I-treated patients.

CONCLUSION

Risk factors for ¹³¹I-induced salivary gland damage include administered ¹³¹I activity, age, gender, history of sialadenitis before ¹³¹I treatment, and AID-SS diagnosis.