{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:24:17Z","timestamp":1787027057375,"version":"build-2736575974"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p>Rituximab, a chimeric anti-CD20 monoclonal antibody, is widely used to treat autoimmune diseases and hematologic malignancies through B-cell depletion, yet paradoxical autoimmune phenomena, including drug-induced lupus erythematosus, have been increasingly recognized. While paradoxical autoimmune phenomena following rituximab therapy have been reported, drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) represents an exceedingly rare complication. This case reports rituximab-induced SCLE in a patient with Sj\u00f6gren\u2019s disease and demonstrates the dual therapeutic efficacy of anifrolumab in managing both drug-induced cutaneous lupus and interferon-driven systemic manifestations. A 69-year-old woman with established primary Sj\u00f6gren\u2019s disease and cryoglobulinemic vasculitis developed biopsy-proven subacute cutaneous lupus erythematosus with clinical onset approximately 4 months following rituximab administration, with histopathological confirmation at Month 9. The patient presented with characteristic erythematous lesions on the trunk and back, which subsequently recurred with extension to the face and d\u00e9collet\u00e9; histopathological examination revealed interface dermatitis and a positive lupus band test on direct immunofluorescence. Treatment with anifrolumab (300\u00a0mg intravenously every 4 weeks) resulted in complete resolution of rituximab-induced SCLE. Subsequent addition of low-dose mycophenolate mofetil (1,000\u00a0mg daily) achieved complete remission of cryoglobulinemic vasculitis, with sustained disease control maintained on this anifrolumab-based regimen. Clinicians should maintain vigilance for paradoxical cutaneous reactions following B-cell-depleting therapies, particularly in patients with underlying Sj\u00f6gren\u2019s disease and anti-Ro\/SSA positivity.<\/jats:p>","DOI":"10.3389\/fphar.2026.1856073","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T10:21:15Z","timestamp":1786962075000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Anifrolumab for rituximab-induced SCLE and cryoglobulinemic vasculitis in primary Sj\u00f6gren\u2019s disease: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"I.","family":"Magi","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences and Community Health, University of Milan","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Bellinvia","sequence":"additional","affiliation":[{"name":"Centro Medico Bellinvia","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Caputo","sequence":"additional","affiliation":[{"name":"Department of Surgical Pathology, ASST Grande Ospedale Metropolitano","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Rongioletti","sequence":"additional","affiliation":[{"name":"Dermatology Clinic, IRCCS San Raffaele Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Bochicchio","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, University of Milan","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. R.","family":"Pellico","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO Institute","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Caporali","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, University of Milan","place":["Milan, Italy"]},{"name":"Department of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO Institute","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Del Papa","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, University of Milan","place":["Milan, Italy"]},{"name":"Department of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO Institute","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"B2","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1111\/j.1365-2133.2012.10825.x","article-title":"The interferon-regulated gene signature is elevated in subacute cutaneous lupus erythematosus and discoid lupus erythematosus and correlates with the cutaneous lupus area and severity index score","volume":"166","author":"Braunstein","year":"2012","journal-title":"Br J Dermatol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1136\/annrheumdis-2012-201381","article-title":"Prevalence of interferon type I signature in CD14 monocytes of patients with sjogren's syndrome and association with disease activity and BAFF gene expression","volume":"72","author":"Brkic","year":"2013","journal-title":"Ann. Rheum. Dis."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1177\/0961203310370349","article-title":"Drug-induced subacute cutaneous lupus erythematosus","volume":"19","author":"Callen","year":"2010","journal-title":"Lupus."},{"key":"B5","doi-asserted-by":"publisher","first-page":"3612","DOI":"10.1002\/art.22211","article-title":"B cell depletion therapy in systemic lupus erythematosus: effect on autoantibody and antimicrobial antibody profiles","volume":"54","author":"Cambridge","year":"2006","journal-title":"Arthritis Rheum."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2672","DOI":"10.1002\/art.38074","article-title":"Elevated serum BAFF levels are associated with rising anti-double-stranded DNA antibody levels and disease flare following B cell depletion therapy in systemic lupus erythematosus","volume":"65","author":"Carter","year":"2013","journal-title":"Arthritis Rheum."},{"key":"B21","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1111\/j.1365-4632.2004.02472.x","article-title":"Coexisting subacute and systemic lupus erythematosus after terbinafine administration: successful treatment with mycophenolate mofetil","volume":"45","author":"Cetkovsk\u00e1","year":"2006","journal-title":"Int. J. Dermatol."},{"key":"B19","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.jaad.2023.02.044","article-title":"Rapid efficacy of anifrolumab in refractory cutaneous lupus erythematosus","volume":"89","author":"Chasset","year":"2021","journal-title":"J. Acad. Dermatol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"233","DOI":"10.7326\/M13-1085","article-title":"Treatment of primary sj\u00f6gren syndrome with rituximab: a randomized trial","volume":"160","author":"Devauchelle-Pensec","year":"2014","journal-title":"Ann. Intern Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1038\/nri1838","article-title":"B-cell targeting in rheumatoid arthritis and other autoimmune diseases","volume":"6","author":"Edwards","year":"2006","journal-title":"Nat. Rev. Immunol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"103262","DOI":"10.1016\/j.autrev.2022.103262","article-title":"Circulating and skin biopsy-present cytokines related to the pathogenesis of cutaneous lupus erythematosus","volume":"22","author":"Erazo-Mart\u00ednez","year":"2023","journal-title":"Autoimmun. Rev."},{"key":"B10","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1002\/art.39962","article-title":"Anifrolumab, an anti-interferon-\u03b1 receptor monoclonal antibody, in moderate-to-severe systemic lupus erythematosus","volume":"69","author":"Furie","year":"2017","journal-title":"Arthritis Rheumatol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e208","DOI":"10.1016\/S2665-9913(19)30076-1","article-title":"Type I interferon inhibitor anifrolumab in active systemic lupus erythematosus (TULIP-1): a randomised, controlled, phase 3 trial","volume":"1","author":"Furie","year":"2019","journal-title":"Lancet Rheumatol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.jaip.2014.12.006","article-title":"Hypersensitivity to biological agents-updated diagnosis, management, and treatment","volume":"3","author":"Galv\u00e3o","year":"2015","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"B13","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.jaci.2018.02.018","article-title":"Hypersensitivity reactions to therapeutic monoclonal antibodies: phenotypes and endotypes","volume":"142","author":"Isabwe","year":"2018","journal-title":"J. Allergy Clin. Immunol."},{"key":"B15","doi-asserted-by":"crossref","first-page":"443","DOI":"10.3109\/08923973.2013.780077","article-title":"Subacute cutaneous lupus erythematosus in the course of rheumatoid arthritis: a relationship with TNF-\u03b1 antagonists and rituximab therapy?","volume":"35","author":"Lis-\u015awi\u0119ty","year":"2013","journal-title":"Immu. Immuno."},{"key":"B16","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1111\/j.1365-2133.2010.10110.x","article-title":"A systematic review of drug-induced subacute cutaneous lupus erythematosus","volume":"164","author":"Lowe","year":"2011","journal-title":"Br. J. Dermatol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1038\/nri2572","article-title":"Cracking the BAFF code","volume":"9","author":"Mackay","year":"2009","journal-title":"Nat. Rev. Immunol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1186\/s13075-015-0678-2","article-title":"The clinical relevance of animal models in Sj\u00f6gren\u2019s syndrome: the interferon signature from mouse to man","volume":"17","author":"Maria","year":"2015","journal-title":"Arthritis Res. Ther."},{"key":"B20","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/S0190-9622(89)80031-3","article-title":"Subacute cutaneous lupus erythematosus lesions precipitated by griseofulvin","volume":"21","author":"Miyagawa","year":"1991","journal-title":"J. Am. Acad. Dermatol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1056\/nejmoa1912196","article-title":"Trial of anifrolumab in active systemic lupus erythematosus","volume":"382","author":"Morand","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"B14","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1111\/1523-1747.ep12476204","article-title":"Ro (SS-A) positive Sj\u00f6gren\u2019s\/lupus erythematosus (SC\/LE) overlap patients are associated with HLA-DR3 and\/or DRw6 phenotypes","volume":"91","author":"Provost","year":"2007","journal-title":"J. Invest. Dermatol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1016\/j.ebiom.2018.12.035","article-title":"B cell alterations during BAFF inhibition with belimumab in SLE","volume":"40","author":"Ramsk\u00f6ld","year":"2019","journal-title":"EBioMedicine"},{"key":"B1","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/j.genhosppsych.2012.03.012","article-title":"Citalopram-induced subacute cutaneous lupus erythematosus \u2013 first case and review concerning photosensitivity in selective serotonin reuptake inhibitors","volume":"34","author":"R\u00f6hrs","year":"2002","journal-title":"Gen. Hosp. Psychiatry."},{"key":"B25","doi-asserted-by":"publisher","first-page":"e37000","DOI":"10.1371\/journal.pone.0037000","article-title":"Type I interferons are associated with subclinical markers of cardiovascular disease in a cohort of systemic lupus erythematosus patients","volume":"7","author":"Somers","year":"2012","journal-title":"PLoS One"},{"key":"B26","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1160\/TH07-08-0513","article-title":"Idiopathic thrombocytopenic purpura: current concepts in pathophysiology and management","volume":"99","author":"Stasi","year":"2008","journal-title":"Thromb. Haemost."},{"key":"B27","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1056\/nejmoa0909905","article-title":"Rituximab versus cyclophosphamide for ANCA-associated vasculitis","volume":"363","author":"Stone","year":"2010","journal-title":"N. Engl. J. Med."}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1856073\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T10:21:17Z","timestamp":1786962077000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1856073\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":26,"alternative-id":["10.3389\/fphar.2026.1856073"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2026.1856073","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]},"article-number":"1856073"}}