000884 - From Drug Hypersensitivity–Associated Ulcerative Lesions to Systemic Lupus Erythematosus: A Case Report

Background:Multiple drug hypersensitivity may reflect underlying immune dysregulation; therefore, we present a patient with recurrent drug hypersensitivity reactions and ulcerative cutaneous lesions with a clinical course that evolved into systemic lupus erythematosus.

Case:A 35-year-old female patient had a long-standing history of hypersensitivity reactions to multiple drug classes. Approximately ten years earlier, she experienced a respiratory anaphylactic reaction following allergen immunotherapy. In subsequent years, she developed optic neuritis and was diagnosed with neuromyelitis optica spectrum disorder, for which immunosuppressive therapy was initiated.

In January 2025, following prolonged antibiotic treatment for a dental infection, the patient developed acute allergic symptoms several hours after drug intake, followed by severe ulcerative cutaneous lesions localized to the nasal region. Infectious causes were excluded. Due to ongoing immunosuppressive therapy, in vitro drug testing could not be performed. Dermatological evaluation, including punch biopsy, revealed findings consistent with discoid lupus erythematosus, accompanied by antinuclear antibody positivity and newly detected anti–double-stranded DNA antibodies.

The cutaneous lesions regressed with dermatological treatment. Over the subsequent months, progressive arthralgia developed, and the diagnosis evolved into systemic lupus erythematosus, which was confirmed by rheumatology. Prior to the initiation of planned immunosuppressive therapy, allergy evaluation including drug provocation testing demonstrated tolerance. The patient remains under multidisciplinary follow-up.

Conclusion

This case highlights the importance of considering immune dysregulation and multidisciplinary evaluation in patients presenting with recurrent drug hypersensitivity reactions and evolving systemic findings.