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Kirkpatrick KV, Nocton JJ. Unusual Presentations of Systemic Lupus Erythematosus. Med Clin North Am 2024; 108:43-57. [PMID: 37951655 DOI: 10.1016/j.mcna.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Systemic lupus erythematosus (SLE) often develops during adolescence, may affect any organ system, and may present with a wide variety of signs and symptoms. It is critical to recognize the unusual manifestations of SLE in order to make a prompt diagnosis. Earlier diagnosis allows for appropriate treatment and ultimately decreases morbidity and mortality.
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Affiliation(s)
- Kaitlin V Kirkpatrick
- Pediatric Rheumatology, Medical College of Wisconsin, Children's Corporate Center, 999 North 92nd Street Suite C465, Milwaukee, WI 53226, USA
| | - James J Nocton
- Pediatric Rheumatology, Medical College of Wisconsin, Children's Corporate Center, 999 North 92nd Street Suite C465, Milwaukee, WI 53226, USA.
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Abuhammad A, AbuKhalaf SM, AbuKhalaf MM, Janem AM, Attawna SIY. Lupus panniculitis as the initial presentation of systemic lupus erythematosus triggered by COVID-19 infection: case report and literature review. Oxf Med Case Reports 2023; 2023:omad129. [PMID: 38033407 PMCID: PMC10686000 DOI: 10.1093/omcr/omad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023] Open
Abstract
COVID-19 has many complications that affect many systems, including rheumatology and inflammatory skin conditions such as cutaneous lupus erythematosus. Herein, we describe the case of a patient with lupus panniculitis who presented with systemic lupus erythematosus in the setting of recent COVID-19 infection. A 66-year-old female patient presented to the hospital with expanded skin lesions all over her limbs, fever, joint pain, and fatigue. Lab tests and imaging revealed a second recent infection with COVID-19, positive titers of systemic lupus erythematosus antibodies, and biopsy confirmed lupus erythematosus panniculitis. She was treated with oral prednisone and hydroxychloroquine for SLE and symptomatic management for recent COVID-19 infection without ICU admission. Lupus erythematosus panniculitis (LEP) is a rare manifestation of lupus erythematosus. Although some cases of SLE following COVID-19 infection have been reported, lupus panniculitis as the initial presentation of systemic lupus erythematosus in these patients is extremely rare.
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Affiliation(s)
- Aseel Abuhammad
- Al-Quds University, Faculty of Medicine, Jerusalem, State of Palestine
| | | | | | | | - Saed I Y Attawna
- Internal Medicine Department, Al-Ahli Hospital, Hebron, State of Palestine
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Daly AU, Riddell C, Ball E, Boyle D, McCourt C, O’Kane D. Lupus profundus-associated SLE: complete remission with combination antimalarial therapy. Scand J Rheumatol 2022; 52:319-320. [PMID: 36445279 DOI: 10.1080/03009742.2022.2144643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- AU Daly
- Department of Dermatology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - C Riddell
- Department of Rheumatology, Musgrave Park Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - E Ball
- Department of Rheumatology, Musgrave Park Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - D Boyle
- Institute of Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - C McCourt
- Department of Dermatology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - D O’Kane
- Department of Dermatology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
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González-Cruz C, Aparicio Español G, Ferrer Fàbrega B, Cabezas Calderón V, Giner Pichel M, García-Patos Briones V. Paniculitis lúpica: características clínico-patológicas de una serie de 12 pacientes. Med Clin (Barc) 2018; 151:444-449. [DOI: 10.1016/j.medcli.2018.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 11/30/2022]
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Abstract
Lupus erythematosus (LE) is termed as an autoimmune chronic condition which involves a spectrum of symptoms. It is a part of the connective tissue diseases. Its cutaneous form is termed as cutaneous lupus erythematosus (CLE). Prevalence of CLE is about 70 cases per 100,000 persons. The least common variety of CLE is lupus profundus (LP)—only 5% of cases. Lupus profundus, although rare, must be kept in the differential diagnoses of ulcerated lesions. It may present as a localized entity or in association with systemic lupus erythematosus (SLE) or it may lead to SLE later in life. Early diagnosis based on histopathology and aggressive treatment is essential to prevent significant physical morbidity and progression to systemic involvement. We report a case of biopsy-proven lupus profundus in a 40-year-old female who presented with high-grade fever and multiple ulcerated lesions. The lesions were appreciated on the left thigh, right gluteus, and left arm. They had an erythematous base and edematous necrotizing centers with purulent discharge. She had a history of oral ulcers, joint pain, photosensitivity, dyspnea, peptic ulcer disease, and signs of depression. Her autoimmune assays were unremarkable. We treated her with antibiotics, oral hydroxychloroquine, and oral corticosteroid. Potassium permanganate wash and methylprednisolone aceponate were applied locally on the lesions. Ulcerated LP is a rare cause of ulcerated/indurated, painful subcutaneous plaques. It may present as a localized entity or in association with SLE or it may lead to SLE later in life.
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Affiliation(s)
- Amber Siddiqui
- Dow University of Health Sciences, Jinnah Sindh Medical University (SMC)
| | - Haseeb A Bhatti
- Department of Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Javeria Ashfaq
- Medicine Ward 3, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Vignesh P, Gupta A, Suri D, Chatterjee D, Saikia UN, Trehan A, Singh S. A Young Child With Fever, Alopecia, and Skin Nodules. Arthritis Care Res (Hoboken) 2017; 70:1238-1244. [PMID: 29161472 DOI: 10.1002/acr.23476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 11/14/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Pandiarajan Vignesh
- Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Aman Gupta
- Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Deepti Suri
- Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Debajyoti Chatterjee
- Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Uma Nahar Saikia
- Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Amita Trehan
- Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Surjit Singh
- Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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Castrillón MA, Murrell DF. Lupus profundus limited to a site of trauma: Case report and review of the literature. Int J Womens Dermatol 2017; 3:117-120. [PMID: 28560307 PMCID: PMC5440450 DOI: 10.1016/j.ijwd.2017.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 01/01/2023] Open
Abstract
Lupus erythematosus profundus (LEP) is a rare form of chronic cutaneous lupus erythematosus. We report on a case of a 56-year-old Caucasian woman who presented with a single, persistent, painful rash on the left hip and lateral aspect of the left upper thigh, which had been present for 2.5 years. The patient had a history of previous injury to this area before the rash started. Clinical findings showed an inflamed, hyperpigmented, and indurated plaque with a linear skin invagination and no associated systemic symptoms. A skin biopsy test result confirmed the diagnosis of LEP and the clinical and laboratory examinations ruled out systemic lupus erythematosus. After 2 months of treatment with methotrexate 20 mg weekly and 1 month of prednisolone 7.5 mg daily, the skin rash improved considerably. We also present a brief review of the epidemiology, etiology, clinical features, histopathology, laboratory findings, differential diagnosis, and treatment of LEP.
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Affiliation(s)
- María Adriana Castrillón
- St. George Hospital, Sydney, Australia.,Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Dédée F Murrell
- St. George Hospital, Sydney, Australia.,University of New South Wales, Sydney, Australia
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van der Geest KS, Moerman RV, Koopmans KP, Holman ND, Janssen WM. Purulent lupus panniculitis unmasked by FDG-PET/CT scan: A case report. Medicine (Baltimore) 2016; 95:e5478. [PMID: 27902603 PMCID: PMC5134781 DOI: 10.1097/md.0000000000005478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
RATIONALE Lupus panniculitis (LP) is a unique variant of cutaneous lupus erythematosus. Clinical manifestations are typically mild and include erythema, nodules, and small ulcers. In certain cases, diagnosing LP may be challenging. Skin overlying the typical subcutaneous inflammation may appear normal, and bacterial superinfections of the skin sometimes mask the underlying LP. It has been suggested that a computed tomography (CT) scan may help to identify obscure LP lesions. Here, we report a case of a 54-year-old woman with an unusually severe form of LP, in which the full disease extent was only revealed by a fluorodeoxyglucose positron emission tomography (FDG-PET)/CT scan. PATIENT CONCERNS/DIAGNOSES/INTERVENTIONS/OUTCOMES Our patient initially presented with a bacterial infection of the skin. After initial improvement with antibiotic treatment, new erythematous lesions and sterile subcutaneous pus collections developed. An FDG-PET/CT scan revealed extensive subcutaneous inflammation at sites that had appeared normal during physical examination and on CT scan. As the subcutaneous lesions showed a remarkably linear pattern on FDG-PET/CT scan, the patient was suspected of having LP. After confirmation of this diagnosis by a deep-skin biopsy, our patient was treated with systemic glucocorticoids. Eventually, our patient succumbed to complications of LP and its treatment. LESSONS Our case demonstrates that clinical manifestations of LP are not always mild and that timely diagnosis is needed. Furthermore, we show that obscure LP lesions are more readily identified on an FDG-PET/CT scan than CT scan.
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Affiliation(s)
| | | | | | - Nicole D. Holman
- Department of Intensive Care Medicine, Martini Hospital, Groningen, The Netherlands
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