Lupus panniculitis as an initial manifestation of systemic lupus erythematosus

Abstract

In May, 2003, a 28-year-old female presented with large non-healing ulcers on face, trunk and limbs covered with black hemorrhagic crust. There were no other systemic manifestations. Diagnosis of lupus panniculitis was considered on clinical and histopathological grounds. The lesions healed completely, with scarring, with systemic corticosteroid, hydroxychloroquine and topical 2% mupirocin. She came again in November, 2005, with malar rash, joint pain, scarring alopecia of the scalp and albuminuria. Her ANA, AntidsDNA came positive and diagnosed as having systemic lupus erythematosus (SLE). She responded well to systemic corticosteroid, antimalarial and topical antibacterial. The evolution of lupus panniculitis is slow and characterized by regression of the inflammatory lesions when treated with antimalarial drugs. The lupus panniculitis generally has a favorable course.

Lupus Panniculitis in Association with Anti-Phospholipid Antibody Syndrome on a Background of Systemic Lupus Erythematosus: A Case Report and Literature Review

“…The disease has a female to male ratio of 2:1, occurring predominantly in the age group of 20-60 years old. 5 The illness manifests itself as deep erythematous plaques and nodules, involving the trunk, breasts, buttocks, face, and proximal extremities. It does not commonly ulcerate.…”

“…The treatment of lupus panniculitis is challenging because there are no specific indications or medication recommendations in the guidelines. 18 Antimalarial drugs are believed to bring improvement in mild cases of isolated lupus panniculitis. 19 Chloroquine in a dose of 200-250 mg a day and HCQ in a dose of 200-400 mg a day is typically recommended.…”

“…HCQ is being used in SLE patients with mild disease and is known to decrease the need for steroids. 18 When lupus panniculitis co-occurs with SLE, a combination of antimalarial and steroids is prescribed. Systemic steroids are reserved for aggressive and resistant cases.…”

“…It usually occurs in the age range of 20-60 years old with a female predominance of 2:1. 2,5 It presents as a firm, fixed, hard skin lesion that may or may not be tender. 6 The diagnosis is usually performed by clinical correlation, histological evidence, immunofluorescence, and autoimmune profile.…”

Lupus erythematosus panniculitis

“…Seventy percent of LEP cases have been associated with DLE but two to five percent of cases have been accompanied by SLE [6,7]. Most cases of LEP have mild and fluctuant courses but up to 15% of cases could be able to progress to SLE and 50% of them have evidences of SLE, so LEP could be a preceding feature of systemic involvement and all patients should be followed up meticulously especially in cases with positive ANA [1,3,[6][7][8]. Arai, et al reported positive ANA in 95.2% of LEP cases [8].…”