Rowell syndrome in dermatological practice (a clinical case)

Cover Page

Cite item


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.
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

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);

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


  1. Иванов ОЛ, Халдин АА, Заборова ВА, Халдина МВ. Современный взгляд на синдром Роуэлла. Российский журнал кожных и венерических болезней. 2003;(1): 20–2.
  2. Каламкарян АА, Мордовцев ВН, Трофимова ЛЯ. Клиническая дерматология. Редкие и атипичные дерматозы. Ереван: Айастан; 1989. 567 с.
  3. Галлямова ЮА. Синдром Роуэлла в практике дерматолога. Лечащий врач. 2011;(10): 22–4.
  4. Беренбейн БА, Шахнес ИЕ. К вопросу о синдроме Роуэлла. Вестник дерматологии и венерологии. 1990;66(1): 60–2.
  5. Молочков ВА, Шахнес ИЕ, Катунцева НН. Синдром Роуэлла. Российский журнал кожных и венерических болезней. 2002;(2): 21–3.
  6. Адаскевич ВП. Неотложная дерматология. М.: Триада-фарм; 2001. 196 с.
  7. Scholtz M. Lupus erythematosus acutus disseminates haemorrhagicus. Arch Dermatol Syphilol. 1922;6:466.
  8. 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. doi: 10.1001/archderm.1963.01590200064012.
  9. Yang S, McHargue Сh. Rowell syndrome: A case of erythema multiforme-like skin lesions in the setting of preexisting subacute cutaneous lupus erythematosus. J Am Acad Dermatol. 2014;70(5 Suppl 1):AB59.
  10. Muller CS, Hinterberger L, Vogt T, Pfohler C. Rowell syndrome – case report with discussion of significance of diagnostic accuracy. BMJ Case Rep. 2011;2011. pii: bcr0920114755. doi: 10.1136/bcr.09.2011.4755.
  11. Camisa C, Sharma HM. Vesiculobullous systemic lupus erythematosus. Report of two cases and a review of the literature. J Am Acad Dermatol. 1983;9(6): 924–33. doi: 10.1016/s0190-9622(83)70210-0.
  12. Hall RP, Lawley TJ, Smith HR, Katz SI. Bullous eruption of systemic lupus erythematosus. Dramatic response to dapsone therapy. Ann Intern Med. 1982;97(2): 165–70. doi: 10.7326/0003-4819-97-2-165.
  13. Vassileva S. Bullous systemic lupus erythematosus. Clin Dermatol. 2004;22(2): 129–38. doi: 10.1016/j.clindermatol.2003.12.020.
  14. Yell JA, Wojnarowska F. Bullous skin disease in lupus erythematosus. Lupus. 1997;6(2): 112– 21. doi: 10.1177/096120339700600206.
  15. Lee S, Schloss E, Kowichi J. Rowell's syndrome: a case report of subacute cutaneous lupus erythematosus and erythema multiforme. Can J Dermatol. 1995;7:807–10.
  16. Zeitouni NC, Funaro D, Cloutier RA, Gagne E, Claveau J. Redefining Rowell's syndrome. Br J Dermatol. 2000;142(2): 343–6. doi: 10.1046/j.1365-2133.2000.03306.x.
  17. Duarte AF, Mota A, Pereira M, Baudrier T, Azevedo F. Rowell syndrome – case report and review of the literature. Dermatol Online J. 2008;14(3): 15.
  18. Torchia D, Romanelli P, Kerdel FA. Erythema multiforme and Stevens-Johnson syndrome/ toxic epidermal necrolysis associated with lupus erythematosus. J Am Acad Dermatol. 2012;67(3): 417–21. doi: 10.1016/j.jaad.2011.10.012.
  19. Subha P, Srivenkateswaran K, Sivasubramanian V, Nydile SV. Rowell syndrome – a rare case report. International Journal of Current Advanced Research. 2019;8(02A):17160–1. doi: 10.24327/ijcar.2019.17161.3203.
  20. Синяченко ОВ, Барабадзе ИВ, Чурилов АВ. Половые и гонадотропные гормоны при патологии мочеполовых органов у больных системной красной волчанкой. Український терапевтичний журнал. 2005;(4): 62–5.
  21. Беренбейн БА, Студницин АА, ред. Дифференциальная диагностика кожных болезней. М.: Медицина; 1989. 672 с.
  22. Bhat RY, Varma C, Bhatt S, Balachandran C. Rowell syndrome. Indian Dermatol Online J. 2014;5(Suppl 1):S33–5. doi: 10.4103/22295178.144526.
  23. Brănișteanu DE, Ianoşi SL, Dimitriu A, Stoleriu G, Oanţă A, Brănișteanu DC. Drug-induced Rowell syndrome, a rare and difficult to manage disease: A case report. Exp Ther Med. 2018;15(1): 785–8. doi: 10.3892/etm.2017.5557.

Supplementary files

There are no supplementary files to display.

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

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies