A 35 year-old woman used Desolett (desogestrel + ethinylestradiol) for a month and then she present

Fråga: A 35 year-old woman used Desolett (desogestrel + ethinylestradiol) for a month and then she presented an agressive systemic Lupus Erythematosus-like picture in her face. Is this effect probably caused by the contraconceptive drug?

Sammanfattning: SLE is a rare, but known, side-effect of oestrogens. In most cases the clinical manifestations disappear after discontinuation of the drug.

Svar: Systemic Lupus Eryhtematosus (SLE) is an infrequent but well-known side-effect of oestrogens (1-3). In those cases laboratory investigations often give results typical of true SLE including the presence of LE cells, antinuclear antibodies, and antibodies to single-strand DNA, but antibodies-DNA-binding capacity has been found negative in the drug-associated SLE, in contradistinction to the finding in true SLE. It is still a matter for speculation whether drug-induced SLE is an entity distinct from the spontaneously occurring type, or whether the administration of certain drugs lead to an exacerbation of SLE by patients in whom the disease has been dormant, or who have a genetic predisposition to the disorder. It is known, however, that some cases may persist after discontinuation of the responsible agent, but recovery is the more likely outcome when the drug is stopped (1).

In Sweden there have been no reports of SLE after treatment with oestrogens. In the United Kingdom four cases have been reported (1).

In a review paper of the actual contraceptive used, on 26000 women (4), no case of SLE was reported. We suggest that this case should be reported to the Swedish Adverse Drug Reactions Committee.