Drug-Induced Lupus Erythematosus Differential Diagnoses

Updated: Jun 23, 2020
  • Author: Catharine Lisa Kauffman, MD, FACP; Chief Editor: Dirk M Elston, MD  more...
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DDx

Diagnostic Considerations

Drug-induced lupus erythematosus (DILE) is characterized by improvement upon withdrawal of the offending drug or agent in a patient with a previously normal immune system. No specific criteria establish the diagnosis of DILE, and excluding underlying autoimmune disease is not a simple process.

Obvious clinical or serologic evidence of DILE is not invariably present, even in rare cases of fatal DILE. Patients who have serologic and clinical findings that normally indicate systemic lupus erythematosus (SLE) might actually have DILE. The symptoms of both drug-induced SLE flares and DILE are temporally related to drug exposure, and the 2 conditions have similar manifestations. Thus, DILE is typically diagnosed by a process of elimination to rule out SLE. Renal idiopathic lupus should also be considered.

For proper diagnosis, the following factors should be preliminarily confirmed:

  • The patient has one or more clinical symptoms of SLE (eg, arthralgias, lymphadenopathy, rash, fever)

  • Antinuclear antibodies are present

  • The patient had no history of SLE before using the culprit drug

  • The drug was taken anytime from 3 weeks to 2 years prior to the appearance of symptoms

  • Clinical improvement is rapid when the drug is discontinued, whereas antinuclear antibodies and other serologic markers slowly decrease toward more normal levels

Differential Diagnoses