Antinuclear antibody-negative, drug-induced lupus caused by lisinopril

South Med J. 2001 Nov;94(11):1122-3. doi: 10.1097/00007611-200111000-00017.

Abstract

The clinical symptoms of drug-induced lupus (DIL) are similar to those of idiopathic systemic lupus erythematosus. The literature indicates that in patients with DIL, sera generally contain antinuclear antibodies (ANAs); however, ANA-negative DIL has been reported. The list of medications implicated as etiologic agents in DIL continues to grow. This list includes two different types of angiotensin-converting enzyme inhibitors--captopril and enalapril. We report the first case of DIL caused by lisinopril. Our patient had negative results on ANA testing and had histone antibodies (IgG anti-[H2A-H2B]-DNA) mirroring the disease course. Antibodies to the (H2A-H2B)-DNA complex are seen in more than 90% of patients with active DIL, excluding those with DIL due to hydralazine. Thus, it is important to recognize the clinical significance of IgG anti-(H2A-H2B)-DNA antibodies and that negative ANA test results do not preclude the diagnosis of DIL.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Angiotensin-Converting Enzyme Inhibitors / adverse effects*
  • Angiotensin-Converting Enzyme Inhibitors / blood
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Antibodies, Anti-Idiotypic / blood
  • Antibodies, Antinuclear / blood*
  • Female
  • Histones / blood
  • Humans
  • Hypertension / blood*
  • Hypertension / drug therapy*
  • Lisinopril / adverse effects*
  • Lisinopril / blood
  • Lisinopril / therapeutic use
  • Lupus Vulgaris / blood*
  • Lupus Vulgaris / chemically induced*

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Antibodies, Anti-Idiotypic
  • Antibodies, Antinuclear
  • Histones
  • anti-IgG
  • Lisinopril