Abstract:

We present the case of a 76-year-old female with erythematous macules on the bilateral arms, hands, legs, and face. The lesions started small, then grew over the ensuing 3 months. Red macules on the extensor arms and lateral thighs evolved into annular lesions with dark centers. New ones appeared daily. The clinical differential was quite broad: lymphomatoid papulosis, arthropod assault, lichenoid drug eruption, lupus, or psoriasis. The patient had a history of sinus infections and had recently taken a 10-day course of Augmentin. The patient was not on any chronic medications other than a once-a-month NSAID. A biopsy of the right popliteal fossa revealed an interface dermatitis with orthokeratosis, epidermal necrosis, and numerous extravasated erythrocytes, compatible with erythema multiforme (EM). The histologic features of EM, typically a rapidly eruptive process, did not correlate well with the 3-month duration of the lesions. The clinical presentation compatible with connective tissue disease, in conjunction with biopsy findings of EM, raised suspicion for Rowell syndrome (RS). A characteristic feature of RS, present in over 80% of cases, is a positive ANA titer specifically in a speckled pattern, corresponding to the anti-Ro antibody. ANA testing was performed, and this pattern was observed. After correlation of the clinical, histologic, and serologic features, a diagnosis of Rowell Syndrome was established. RS is a rare condition; worldwide, fewer than 100 cases have been documented. It can be due to certain drugs such as terbinafine, omeprazole, norfloxacin, and sodium valproate. RS can be easily missed if dermatologists and pathologists are not alert to key features. Patients generally respond well to therapy. We summarize the important features of RS and review the available literature on that diagnosis.

Financial Disclosure:
No current or relevant financial relationships exist.

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Aarun Devgan, Undergraduate