An unusual clinical presentation of lupus erythematosus tumidus localized on the thigh

Abstract

A 44-year-old woman with seronegative polyarthritis presented with a 2-year history of a solitary, bluish-red, oedematous, nonscaly, annular and partially reticulated macule on her right thigh. Histopathological findings revealed perivascular and periadnexal lymphocytic infiltrate in the dermis. Alcian blue and colloidal iron stains highlighted mucinous deposit in the upper and mid dermis. Direct immunofluorescence showed a linear deposit of IgG and C3 along the basement membrane zone. Antinuclear antibody was positive at a titre of 1 : 80, with homogenous and speckled patterns. Except for its unusual localization and lack of photosensitivity, our case had the clinical and histopathological features of lupus erythematosus tumidus. These characteristics were also reminiscent of reticular erythematous mucinosis and erythema annulare centrifugum, both of which are considered to be associated with cutaneous lupus erythematosus (CLE). Hydroxychloroquine 200 mg daily led to improvement of the skin lesion. The unusual clinical presentation of our case emphasizes the heterogeneity of clinical manifestations of CLE.

Direct Immunofluorescence in Cutaneous and Systemic Lupus Erythematosus: A Literature Review

“…52 The positive yield of tumid LE in DIF tests was 26.7%-100%. [52][53][54][55] The deposits of immunoreactants were mainly at the DEJ [52][53][54][55]. ENS or DLP was rarely detected in a DIF test of tumid LE.…”

A case of lupus erythematosus tumidus misdiagnosed as erysipelas

“…A case of LET which skin lesion confined to the thigh was reported abroad. 12 Sun also reported a LET manifest as a giant edematous erythema and involving half of the entire face asymmetrically. 13 Chen reported a case of LET converted from DLE with prominent swelling of the eyelids, a low-grade fever and myalgia, which was also diagnosed as erysipelas at the local hospital.…”