Issue 8/2026
Vasilev1,2, T. , Temelkova1,2, K., Kibarova-Hristova1,2, D., Francheshkova1,2, D., Vuchkova1,2, A.
Chervenlieva1, I., Stoyanova1, Z., Stefanov2, St.
1 Clinic of Rheumatology, Children’s Hospital “Ivan Mitev” – Sofia
2 Department of Pediatrics; Medical University – Sofia
Drug-induced lupus (DIL) is an uncommon acquired autoimmune disorder characterized by lupus-like clinical and immunological manifestations triggered by prolonged exposure to specific medications. During the last two decades, the spectrum of causative agents has shifted considerably from the classic high-risk drugs toward minocycline, tumor necrosis factor-alpha (TNF-α) inhibitors, and other biologic and targeted therapies. Although DIL remains rare in childhood, its incidence is expected to increase in parallel with the expanding use of these agents in pediatric practice. This review summarizes current evidence regarding the epidemiology, immunopathogenesis, genetic susceptibility, causative drugs, clinical presentation, laboratory and immunological findings, differential diagnosis, treatment, and prognosis of DIL, with particular emphasis on pediatric patients. The review discusses the principal immunological mechanisms involved in disease development, including impaired DNA methylation, the formation of anti-histone antibodies, and interferon-driven autoimmunity associated with different drug classes. Evidence from pivotal clinical studies and recent high-quality reviews is integrated with practical recommendations for the early recognition of DIL in outpatient practice. Early identification and withdrawal of the offending medication remain the cornerstone of management and are associated with an excellent prognosis in most pediatric patients, preventing unnecessary immunosuppressive treatment.
Key words: drug-induced lupus; anti-histone antibodies; autoimmunity.
Address for correspondence:
Teodor Vasilev, MD, PhD
Clinic of Rheumatology,
Children’s Hospital “Ivan Mitev” – Sofia
11, „Аcad. Ivan Geshov“, Blvd.
1612, Sofia
e-mail: tvasilev@medfac.mu-sofia.bg