Images in Clinical Rheumatology
Rowell's Syndrome: The Two Sides of the Truth
Síndrome de Rowell: las 2 caras de la verdad
Juan Francisco López Caleyaa,
, Laura Martín Rodrigob, Pablo Gonzalvo Rodriguezc, Yolanda Hidalgo Garcíad
Corresponding author
a Servicio de Medicina Interna, Hospital de Cabueñes, Gijón, Asturias, Spain
b Servicio de Medicina Interna, Fundación Hospital de Jove, Gijón, Asturias, Spain
c Servicio de Anatomía Patológica, Hospital de Cabueñes, Gijón, Asturias, Spain
d Servicio de Dermatología, Hospital de Cabueñes, Gijón, Asturias, Spain
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(B) Trunk involvement.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 2000, Zeitouni et al. updated the diagnostic criteria of Rowell's syndrome (RS).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> They included the development of lupus erythematosus (LE) in its systemic, discoid and subacute cutaneous forms, erythema multiforme (EM) and antinuclear antibodies (ANA) (a speckled pattern) as the more important criteria. Moreover, they associated rheumatoid factor (RF), positive anti-Ro/SS-A or anti-La/SS-B antibodies and pernio (chilblains) as less significant criteria.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 91-year-old woman with a 2-month history of generalized itching and painful dermatitis, with a poor response to corticosteroid therapy. She had not had infections or previous use of these medications.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The physical examination showed a scaly, maculopapular eczema, with crusting areas in trunk and all 4 extremities, creating a typical result has shown (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The laboratory tests included RF (83.1<span class="elsevierStyleHsp" style=""></span>IU/mL), ANA (1/2560 speckled pattern) and positive anti-Ro/SSA and anti-La/SSB. The skin biopsy was compatible with LE and EM (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">For some authors, the coexistence of LE and EM are not considered different entities.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">It is difficult to distinguish between subacute cutaneous LE (SCLE) and EM.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> However, other authors insist that the classical EM be acute and self-limited, and that the lesions be bull's-eyes. This is commonly associated with infections and previous drug exposure.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In RS, the typical findings are recurrent, EM-like lesions, with no triggering factors and with positive antibodies and RF.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The speckled pattern of the ANA is the immunological characteristic most consistent of RS, appearing in 60.4% to of the cases, although it is not exclusive of this condition.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Therapy should be initiated with corticosteroid and hydroxychloroquine. In some cases, success was obtained with dapsone, cyclosporine or azathioprine.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Although the pathological finding is not a diagnostic criterion, it is indispensable for the identification of this disorder.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The diagnostic criteria should be reviewed in order to limit the forms of LE and to assess the need of EM-like lesions without a known triggering agent as essential.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest with regard to this work.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-09-18" "fechaAceptado" => "2015-11-05" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López Caleya JF, Martín Rodrigo L, Gonzalvo Rodriguez P, Hidalgo García Y. Síndrome de Rowell: las 2 caras de la verdad. Reumatol Clin. 2016;12:354–355.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 746 "Ancho" => 1749 "Tamanyo" => 228971 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Scaly, maculopapular eczema on trunk and extremities. (B) Trunk involvement.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 728 "Ancho" => 1800 "Tamanyo" => 379744 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Epidermis with vacuolar degeneration of the basal cells (asterisks), isolated necrotic keratinocytes (arrows) and associated lymphocyte infiltrate. The image shows the verticality of the basal cells (arrowheads), a histological feature associated with erythema multiforme. Infiltrated lymphocytes and melanophages in papillary dermis. (B) Reticular dermis with interstitial mucin (asterisks).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lupus erythematosus and erythema multiforme-like lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.R. Rowell" 1 => "S. Beck" 2 => "J.R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 12 | 26 |
| 2024 October | 84 | 30 | 114 |
| 2024 September | 111 | 25 | 136 |
| 2024 August | 103 | 43 | 146 |
| 2024 July | 67 | 35 | 102 |
| 2024 June | 67 | 32 | 99 |
| 2024 May | 92 | 32 | 124 |
| 2024 April | 92 | 28 | 120 |
| 2024 March | 109 | 36 | 145 |
| 2024 February | 68 | 28 | 96 |
| 2024 January | 71 | 27 | 98 |
| 2023 December | 83 | 26 | 109 |
| 2023 November | 114 | 41 | 155 |
| 2023 October | 76 | 26 | 102 |
| 2023 September | 164 | 37 | 201 |
| 2023 August | 82 | 12 | 94 |
| 2023 July | 74 | 34 | 108 |
| 2023 June | 72 | 30 | 102 |
| 2023 May | 88 | 24 | 112 |
| 2023 April | 72 | 15 | 87 |
| 2023 March | 126 | 29 | 155 |
| 2023 February | 114 | 43 | 157 |
| 2023 January | 97 | 17 | 114 |
| 2022 December | 114 | 36 | 150 |
| 2022 November | 91 | 32 | 123 |
| 2022 October | 105 | 49 | 154 |
| 2022 September | 90 | 43 | 133 |
| 2022 August | 109 | 65 | 174 |
| 2022 July | 102 | 40 | 142 |
| 2022 June | 98 | 38 | 136 |
| 2022 May | 108 | 47 | 155 |
| 2022 April | 95 | 59 | 154 |
| 2022 March | 76 | 49 | 125 |
| 2022 February | 85 | 42 | 127 |
| 2022 January | 96 | 46 | 142 |
| 2021 December | 76 | 38 | 114 |
| 2021 November | 96 | 44 | 140 |
| 2021 October | 134 | 62 | 196 |
| 2021 September | 105 | 42 | 147 |
| 2021 August | 74 | 44 | 118 |
| 2021 July | 75 | 31 | 106 |
| 2021 June | 82 | 28 | 110 |
| 2021 May | 80 | 57 | 137 |
| 2021 April | 284 | 102 | 386 |
| 2021 March | 157 | 42 | 199 |
| 2021 February | 86 | 19 | 105 |
| 2021 January | 99 | 38 | 137 |
| 2020 December | 93 | 25 | 118 |
| 2020 November | 73 | 18 | 91 |
| 2020 October | 74 | 13 | 87 |
| 2020 September | 59 | 25 | 84 |
| 2020 August | 49 | 15 | 64 |
| 2020 July | 57 | 13 | 70 |
| 2020 June | 40 | 21 | 61 |
| 2020 May | 45 | 21 | 66 |
| 2020 April | 33 | 20 | 53 |
| 2020 March | 17 | 4 | 21 |
| 2020 February | 1 | 0 | 1 |
| 2018 December | 2 | 0 | 2 |
| 2018 May | 5 | 1 | 6 |
| 2018 April | 55 | 9 | 64 |
| 2018 March | 101 | 8 | 109 |
| 2018 February | 34 | 8 | 42 |
| 2018 January | 42 | 6 | 48 |
| 2017 December | 52 | 14 | 66 |
| 2017 November | 37 | 14 | 51 |
| 2017 October | 53 | 13 | 66 |
| 2017 September | 37 | 11 | 48 |
| 2017 August | 30 | 17 | 47 |
| 2017 July | 45 | 11 | 56 |
| 2017 June | 39 | 14 | 53 |
| 2017 May | 40 | 20 | 60 |
| 2017 April | 46 | 14 | 60 |
| 2017 March | 32 | 9 | 41 |
| 2017 February | 17 | 7 | 24 |
| 2017 January | 47 | 27 | 74 |
| 2016 December | 62 | 37 | 99 |
| 2016 November | 47 | 42 | 89 |
| 2016 October | 16 | 19 | 35 |
| 2016 September | 8 | 11 | 19 |
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