A Rare Case of Systemic Lupus Erythematosus Manifesting as Genital Ulcers

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease affecting multiple organ systems. In this report, we discuss the case of a patient with a history of idiopathic thrombocytopenic purpura (ITP), hypothyroidism, SLE, and Crohn's disease (CD) who presented to the emergency room with fever, burning micturition, abdominal pain, and perineal ulcers. Upon subsequent treatment for urinary tract infections (UTI) and negative evaluations for an infectious cause of genital ulcers like sexually transmitted diseases, the etiology of ulcers was found to be SLE. This case report highlights the importance of including SLE ulcers in the differential diagnosis when an SLE patient presents with genital ulcers and the importance of ruling out an SLE vs. infection or non-infection as the cause of ulcers in a former SLE patient.

Genital ulcers associated with systemic lupus erythematosus – what are the possible causes? A Case Report

“…In most cases, skin lesions in SLE occur in sun-exposed areas [ 10 ] . Mucosal involvement is frequently manifested in lupus as ulcers in the mouth, less frequently in the nose and throat and rarely in the genital area [ 11 ] . Behçet’s disease presenting as genital ulcer was excluded in our patient as she had the diagnostic criteria of SLE [ 8 ] .…”

“…SLE genital involvement presented as small–medium size, papular ulcers with well-demarcated borders. These lesions are seen in both discoid lupus and SLE [ 7 , 11 , 12 ] .…”

“…papular ulcers with well-demarcated borders. These lesions are seen in both discoid lupus and SLE [7,11,12] . The pathophysiology of ulceration in the setting of immune dysregulation remains largely unknown, although histologic examination has shown inflammatory infiltrate, likely involving activation of T cells, and release of tumor necrosis factor alpha [10,11] .…”

“…These lesions are seen in both discoid lupus and SLE [7,11,12] . The pathophysiology of ulceration in the setting of immune dysregulation remains largely unknown, although histologic examination has shown inflammatory infiltrate, likely involving activation of T cells, and release of tumor necrosis factor alpha [10,11] . In establishing a differential diagnosis of the genital ulcers, we considered sexually transmitted diseases, infections, dermatologic diseases-related, related systemic diseases such as Crohn's disease (CD), malignancies, traumatic ulcers, and idiopathic disease [12] .The diagnosis of Behçet's disease can be confidently made if there are at least three reported episodes of mouth ulcers over the past 12 months and the presence of two of the following symptoms: genital ulcers, ocular manifestation, dermatologic manifestation and positive pathergy reaction [13] .…”

“…Our patient had been treated with prednisolone and hydroxychloroquine, with a good response. An untreated ulcer could progress to squamous cell carcinoma [11] . Romiti and colleagues [16] prescribed prednisolone in two cases of discoid lupus erythematosus affecting the genital area, with widespread discoid lesions on the head.…”