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Ticlopidine-Induced Lupus
A Report of 4 Cases
Robert F. Spiera, MD;
Rosanne S. Berman, MPH;
Andrew J. Werner, MD;
Harry Spiera, MD
Arch Intern Med. 2002;162:2240-2243.
Drug-induced lupus has been associated with various medications. Ticlopidine
hydrochloride is a platelet aggregation inhibitor that has been associated
with thrombotic thrombocytopenic purpura, which is believed to be immune mediated.
We describe 4 patients with drug-induced lupus following the institution of
ticlopidine therapy. The 4 patients, who had systemic lupus erythematosus
following ticlopidine use, were examined between 1997 and 1999. The clinical
features of these patients, namely, older age of onset, presence of pleurisy
and arthritis, and paucity of central nervous system, renal, or skin involvement,
are consistent with drug-induced lupus. All had detectable antihistone antibodies.
All 4 patients had clinical and serological improvement following ticlopidine
withdrawal, allowing cessation or reduction of corticosteroid therapy. We
suspect that ticlopidine can cause drug-induced lupus, and that this exposure
should be considered particularly in the examination of elderly patients with
systemic lupus erythematosus.
From the Division of Rheumatology, Beth Israel Medical Center (Dr R.
F. Spiera and Ms Berman), and Department of Medicine, Mount Sinai School of
Medicine (Drs Werner and H. Spiera), New York, NY.
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