When Chest Pain Reveals More: A Case of Hydrochlorothiazide-Induced Systemic Lupus Erythematosus.

BACKGROUND Drug induced lupus erythematosus is considered an autoimmune entity which is precipitated by medications. Hydrochlorothiazide has been recognized to cause subacute cutaneous lupus erythematosus, but very few cases of systemic drug induced lupus systemic erythematosus have been reported. CASE REPORT A 57-year-old Caucasian male with a past medical history of hypertension and hyperlipidemia presented with recurrent fevers, chest pain, and dyspnea. Initial evaluation revealed diffuse ST elevations, small pericardial effusion, anemia, and leukopenia. He was initially treated with nonsteroidal anti-inflammatory drugs and prednisone for pericarditis. Six months later, he reported fatigue, arthralgias, morning stiffness, weight loss, fevers, and night sweats. Laboratory tests revealed persistent anemia and leukopenia. Extensive workup, including bone marrow biopsy and infectious evaluations, was negative. Autoimmune workup, however, revealed positive antihistone and antichromatin antibodies despite negative antinuclear antibody. A diagnosis of drug induced lupus secondary to hydrochlorothiazide was made. The medication was stopped, and prednisone was initiated resulting in marked improvement in his symptoms and hematologic abnormalities. CONCLUSIONS This report is one of the few known cases of systemic lupus erythematosus most likely induced by hydrochlorothiazide. Based on our finding, hydrochlorothiazide should be considered a possible offending agent when a patient presents with symptoms suspicious of drug induced lupus.

EXPLORING EQUALITY IN LEADERSHIP ROLES.

Women are underrepresented in physician leadership. Exploring the issue, researchers created a study focused on developing successful skills, behaviors and attitudes for 15 first-year female residents. In 2016, the American Association for Physician Leadership* named Advocate Health Care's Resident Leadership Develop- ment Institute the winner of its annual Leape Ahead Award. It recognizes organizations devoted to patient safety, health care improvement and developing future physician leaders. This article summarizes and includes excerpts from the comprehensive presentation that earned the award. Evaluators were impressed by the research focusing on leadership de- velopment for female residents, saying its assessment and metrics, as well as its mentoring of participants, made the program stand out. Learn about the recipient of the 2017 Leape Ahead Award, MUSC Health at Medical University of South Carolina, in our news section, which begins on page 62.