Sachiko Katsumi

Development of systemic sclerosis in a patient with systemic lupus erythematosus and topoisomerase I antibody

We describe a patient with systemic lupus erythematosus (SLE) associated with topoisomerase I (topo I, Scl‐70) antibody, a specific marker for systemic sclerosis (SSc). SSc patients who produce this antibody have severe cutaneous and visceral involvement, and eventually have a poor prognosis. It is rare to find this antibody in patients with other collagen diseases. Only four SLE patients have been reported in the English language literature who were topo I antibody‐positive but had no clinical evidence of scleroderma. The serum of our patient with SLE had precipitating topo I antibody from the onset of his disease. Twelve years after the onset of SLE, he developed proximal scleroderma and pulmonary fibrosis. This case reconfirms the prognostic significance of topo I antibody as a predictive marker, and indicates that SLE patients with topo I antibody require careful follow‐up for future development of scleroderma.

Bucillamine‐Induced Toxic Epidermal Necrolysis and Fixed Drug Eruption

We report two cases of bucillamine‐induced bullous reactions with keratinocyte necrosis. The first patient, a 27‐year‐old woman, developed toxic epidermal necrolysis (TEN) over her whole body after taking bucillamine 300 mg/day for seven days. The second patient, a 63‐year‐old woman, developed several bullous erythemas on the mucous membranes and legs after taking bucillamine for more than two years. The fixed drug eruptions were diagnosed based on a provocation test in addition to clinical and histopathologic findings. These cases highlight the importance of considering fixed drug eruption as well as TEN in the differential diagnosis of bucillamine‐induced bullous drug eruption.