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Table of Contents
LETTER TO THE EDITOR
Year : 2021  |  Volume : 12  |  Issue : 4  |  Page : 245

Acute cutaneous lupus erythematosus


1 Division of Infectious Disease, University of Louisville, Louisville, USA
2 Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Date of Submission17-Apr-2021
Date of Acceptance20-May-2021
Date of Web Publication20-Oct-2021

Correspondence Address:
Dr. Latika Gupta
Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injms.injms_51_21

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How to cite this article:
Manish K C, Gupta L. Acute cutaneous lupus erythematosus. Indian J Med Spec 2021;12:245

How to cite this URL:
Manish K C, Gupta L. Acute cutaneous lupus erythematosus. Indian J Med Spec [serial online] 2021 [cited 2022 Dec 9];12:245. Available from: http://www.ijms.in/text.asp?2021/12/4/245/328642



A 32-year-old female presented with facial rash for 2 years with subsequent development of rash over hands and anterior chest, oral ulcer, photosensitivity, and hair loss. She also presented with fatigue, myalgia, arthralgia, and intermittent chest pain. On physical examination, classical malar rash [Figure 1]a was found sparing nasolabial folds. Hyperpigmented, erythematous rashes were found on the anterior chest, forearm, and hands. Erythematous rashes were noted on the dorsum of hands, with remarkable sparing of knuckles.[Figure 1]b
Figure 1: Rashes in systemic lupus erythematosus. (a) Classic malar rash in systemic lupus erythematosus. (b) Rash in hands in systemic lupus erythematosus

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On laboratory examination, bicytopenia (anemia and thrombocytopenia), speckled antinuclear antibodies (1:1280), positive dsDNA (300 IU/ml), and proteinuria (urine albumin 1+) were found. Skin biopsy showed parakeratosis, spongiosis, and extensive basal cell damage with perivascular inflammatory infiltrate consisting of lymphocytes and histiocytes. A diagnosis of systemic lupus erythematosus (SLE) was made.

Cutaneous involvement is a major tell-tale feature of lupus erythematosus (SLE), occurring in nearly 80% of cases at some point in time.[1] On occasion, malar and extremity rashes of SLE may be confused with those in dermatomyositis (DM), more so in the absence of frank muscle involvement in DM.[2] Malar rash in DM typically involves the nasolabial folds, and extremity rashes are largely confined to knuckles on the hands - a key feature while discerning the diagnosis in the clinic.[1]

Histopathological examination in SLE and DM has similar findings though direct immunofluorescence microscopic examination may be discriminative, with immunoglobulin and complement deposits in SLE but not DM.[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rothfield N, Sontheimer RD, Bernstein M. Lupus erythematosus: Systemic and cutaneous manifestations. Clin Dermatol 2006;24:348-62.  Back to cited text no. 1
    
2.
Gupta L, Naveen R, Gaur P, Agarwal V, Aggarwal R. Myositis-specific and myositis-associated autoantibodies in a large Indian cohort of inflammatory myositis. Semin Arthritis Rheum 2021;51:113-20.  Back to cited text no. 2
    
3.
Kazandjieva J, Tsankov N, Pramatarov K. The red face revisited: Connective tissue disorders. Clin Dermatol 2014;32:153-8.  Back to cited text no. 3
    


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