Lupus Panniculitis as an Initial Manifestation of Systemic Lupus Erythematosus: A Case Report

Abstract

Lupus erythematosus panniculitis (LEP) is a variant of chronic cutaneous lupus erythematosus (CCLE). Reported cases of LEP lesions before the diagnosis of systemic lupus erythematosus (SLE) were very rare; only 9 cases have been reported, to the best of our knowledge. We now describe the case of a 19-year-old male patient, with an overall review of the English literature. In the earliest stage of the present case, nodules and ulcers involved his left leg and face, with no other accompanied symptoms. The skin lesions disappeared after treatment with methylprednisolone, 16 mg/d for 1 month. Seven months after discontinuing methylprednisolone, the cutaneous nodules and ulcers on his back recurred and were accompanied by fever, hair loss, and polyarthritis. Blood tests revealed leucopenia, positive antinuclear antibody and Smith antibody, and proteinuria. Histopathological findings were most consistent with LEP. This was followed sequentially by the diagnosis of SLE. The patient improved again after treatment with methylprednisolone and cyclophosphamide.Patients with LEP should have regular follow-ups because the development of SLE is possible. Early diagnosis and proper treatment is pivotal to improve the prognosis of such patients.

FIGURE 1

(A) Two red subcutaneous nodules (red arrows) and multiple well-defined deep ulcers on the patient's back. (B) After 2 months of treatment, the ulcers and nodules had substantially improved.

FIGURE 2

(A) Perivascular and periadnexal lymphocytic infiltrations from the upper dermis to the deep dermis. (B) A profile of lymphocytic mixed panniculitis with hyaline necrosis (red arrows) of the subcutaneous fat. (C) Lymphocytic vasculitis in the interlobular septa. (D) Fibrin thrombosis in the interlobular septa (red arrows; the area squared in black is magnified at the bottom right). (A, original magnification 40×; B, original magnification 100×; C, original magnification 400×; D, original magnification 100×, hematoxylin-eosin).