Rowell syndrome in dermatological practice (a clinical case)

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Abstract

Rowell syndrome is a  rare cluster of symptoms characterized by clinical manifestation of lupus erythematosus and erythema multiforme (EM). About 100  cases of the syndrome have been reported in medical publications during the last 100 years. This may be related to misinterpretation of the symptoms and subsequent incorrect diagnosis due to its EM-like manifestations. Important clues for the diagnosis of Rowell syndrome are findings of positive rheumatoid factor, anti-nuclear antibodies and other erythematoid markers, as well as additional investigations, in particular, direct immunofluorescence technique. The paper describes a  clinical case of Rowell syndrome in a 16-year old male patient. The diagnosis was challenging due to EM-like skin manifestations and required additional laboratory work-up, as well as the patient's follow-up. The diagnosis of Rowell syndrome was based on the clinical manifestations and on such diagnostic criteria as positive rheumatoid factor and anti-nuclear antibodies, as well as histological and laboratory abnormalities characteristic of the erythematosis. The patient was hospitalized and received the following treatment: prednisolone infusion (2.5 mg/kg/daily for 7 days), chloropyramine (1 mL i.m. twice daily for 5  days), hydroxychloroquine (6.5  mg/kg daily for 5  days), magnesium asparaginate/potassium asparaginate (one tablet (166.3  mg/175  mg) 3  times daily for 7  days), topical methylprednisolone aceponate cream 1% (once daily for 7 days). The treatment resulted in positive changes in the skin lesion and improvement of his general state. This clinical observation gives an example of classic Rowell syndrome proven both by lab and clinical signs, taking into account skin symptoms of lupus erythematosus and EM-like rash.

About the authors

A. V. Taganov

Peoples' Friendship University of Russia (RUDN University)

Author for correspondence.
Email: matis87177@yandex.ru
ORCID iD: 0000-0001-5056-374X

Alexey V. Taganov – MD, PhD, Professor of the Chair of Dermatology and Venerology, Faculty of Continuing Medical Education, Institute of Medicine

6 Miklukho-Maklaya ul., Moscow, 117198

Russian Federation

O. B. Tamrazova

Peoples' Friendship University of Russia (RUDN University);
Bashlyaeva Children's City Clinical Hospital

Email: anait_tamrazova@mail.ru
ORCID iD: 0000-0003-3261-6718

Olga B. Tamrazova – MD, PhD, Professor of RAS, Professor of the Chair of Dermatology and Venerology, Faculty of Continuing Medical Education, Institute of Medicine Peoples' Friendship University of Russia (RUDN University); Consultant Physician Bashlyaeva Children's City Clinical Hospital

6 Miklukho-Maklaya ul., Moscow, 117198, 
28 Geroev Panfilovtsev ul., Moscow, 125373

Russian Federation

M. A. Gureeva

Peoples' Friendship University of Russia (RUDN University);

Email: m.gureeva1@gmail.com
ORCID iD: 0000-0001-8212-6210

Мarina A. Gureeva – MD, Assistant of the Chair of Dermatology and Venerology, Faculty of Continuing Medical Education, Institute of Medicine

6 Miklukho-Maklaya ul., Moscow, 117198

Russian Federation

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Copyright (c) 2019 Taganov A.V., Tamrazova O.B., Gureeva M.A.

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