1
|
Boussaid S, Ben Majdouba M, Rekik S, Jemmali S, Zouaoui K, Rahmouni S, Sahli H, Elleuch M. Case Report: Extensive digital gangrene as a primary manifestation of late-onset systemic lupus erythematosus. F1000Res 2022; 11:922. [PMID: 38813136 PMCID: PMC11134139 DOI: 10.12688/f1000research.124225.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 05/31/2024] Open
Abstract
Background: Digital gangrene is a rare but serious complication of systemic lupus erythematosus (SLE). It occurs usually in middle-aged patients with longer disease duration. Case: Herein we report the case of a 56-year-old man (with no history suggestive of Raynaud's phenomenon, diabetes mellitus, smoking, trauma, infection, or chemical exposure), who presented with SLE and digital gangrene was among the first signs. He presented with a one-month history of joint pain, hair loss, photosensitivity, mouth ulcers, malar rash, dyspnea, and digital pain. Physical examination revealed painful and diffuse erythematous skin lesions in the extremities and back, as well as cyanosis in the fingers. We noted lymphocytopenia (600 cells/mm 3), and an elevated C-reactive protein (15.1 mg/l) on laboratory tests. Immunological tests were positive for antinuclear antibodies (ANA) with Title 1:400. Pulmonary computed tomography revealed pulmonary fibrosis, and pulmonary function tests revealed the restrictive pulmonary disease. Diagnosis of SLE with lung involvement was retained. The immunological assessment in search of elements in favor of a vascular origin of the patient's skin lesions was negative. Treatment was initiated with 200 mg/day hydroxychloroquine. For dermal and pulmonary involvement, intravenous (IV) pulse therapy was used with methylprednisolone (1,000 mg/d for three consecutive days monthly) and cyclophosphamide (1 g/month). Calcium blocking agents were also prescribed. However, the lesions did not improve. The patient was given two infusions of rituximab (1 g) at a 14-day interval with a marked improvement ofthe majority of vasculitis lesions, and a partial improvement of dyspnea. Conclusions: Digital gangrene is a rare complication of late-onset SLE, especially as a primary manifestation.
Collapse
Affiliation(s)
- Soumaya Boussaid
- Rheumatology Department, La Rabta Hospital, La Rabta Jebbari, Tunis, 1007, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, La Rabta Jebbari, Tunis, 1007, Tunisia
- Research unit LR 05 SP 01, La Rabta Hospital, La Rabta Jebbari, Tunis, 1007, Tunisia
| | - Marouene Ben Majdouba
- Rheumatology Department, La Rabta Hospital, La Rabta Jebbari, Tunis, 1007, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, La Rabta Jebbari, Tunis, 1007, Tunisia
| | - Sonia Rekik
- Rheumatology Department, La Rabta Hospital, La Rabta Jebbari, Tunis, 1007, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, La Rabta Jebbari, Tunis, 1007, Tunisia
- Research unit LR 05 SP 01, La Rabta Hospital, La Rabta Jebbari, Tunis, 1007, Tunisia
| | - Samia Jemmali
- Rheumatology Department, La Rabta Hospital, La Rabta Jebbari, Tunis, 1007, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, La Rabta Jebbari, Tunis, 1007, Tunisia
- Research unit LR 05 SP 01, La Rabta Hospital, La Rabta Jebbari, Tunis, 1007, Tunisia
| | - Khaoula Zouaoui
- Rheumatology Department, La Rabta Hospital, La Rabta Jebbari, Tunis, 1007, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, La Rabta Jebbari, Tunis, 1007, Tunisia
- Research unit LR 05 SP 01, La Rabta Hospital, La Rabta Jebbari, Tunis, 1007, Tunisia
| | - Safa Rahmouni
- Rheumatology Department, La Rabta Hospital, La Rabta Jebbari, Tunis, 1007, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, La Rabta Jebbari, Tunis, 1007, Tunisia
- Research unit LR 05 SP 01, La Rabta Hospital, La Rabta Jebbari, Tunis, 1007, Tunisia
| | - Hela Sahli
- Rheumatology Department, La Rabta Hospital, La Rabta Jebbari, Tunis, 1007, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, La Rabta Jebbari, Tunis, 1007, Tunisia
- Research unit LR 05 SP 01, La Rabta Hospital, La Rabta Jebbari, Tunis, 1007, Tunisia
| | - Mohamed Elleuch
- Rheumatology Department, La Rabta Hospital, La Rabta Jebbari, Tunis, 1007, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, La Rabta Jebbari, Tunis, 1007, Tunisia
| |
Collapse
|