Unilateral facial erythematous patch as the presenting sign of systemic lupus erythematosus

Lupus ◽  
2020 ◽  
Vol 29 (14) ◽  
pp. 1968-1970
Author(s):  
Dae-Lyong Ha ◽  
Gi-Wook Lee ◽  
Kihyuk Shin ◽  
Hoon-Soo Kim ◽  
Hyun-Chang Ko ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Autoimmune Disorder ◽  
Left Cheek ◽  
Systemic Lupus ◽  
Diagnostic Challenge ◽  
Cutaneous Manifestations ◽  
Oral Ulcers ◽  
Rare Manifestation ◽  
History Of

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that can have many cutaneous manifestations including malar rash, discoid rash or oral ulcer. Isolated unilateral involvement of face is uncommon in SLE. It lacks typical clinical features of LE, and may impose a diagnostic challenge for clinicians. Herein we report a case of 62-year-old woman presenting with a 2-year history of erythematous patches on left cheek and eyelid. Initially, she was diagnosed as having recurrent blepharitis or cellulitis that did not respond to conventional treatment with ophthalmic medicaments. As time went by, the patches spread to her left cheek, and she was referred to our dermatologic department. Histopathologic examination was consistent with LE. Further physical and laboratory tests have found that she had oral ulcers, proteinuria, thrombocytopenia and abnormal titer of anti-nuclear antibody satisfying the diagnosis of SLE. From this case, we think unilateral erythematous patches on face could be a rare manifestation of SLE and more intention should be paid to this type of patients, because unilateral facial symptom may mimic other dermatoses.

scholarly journals When systemic lupus erythematosus affects vision: a rare presentation of this condition

2020 ◽  
Vol 13 (1) ◽  
pp. e229382
Author(s):  
Tiago Gama Ramires ◽  
Luísa Vieira ◽  
Nuno Riso ◽  
Maria Francisca Moraes-Fontes
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Blurred Vision ◽  
Rare Presentation ◽  
Complement Components ◽  
Oral Ulcers ◽  
Dsdna Antibody ◽  
Rare Manifestation ◽  
Retinal Vascular Tortuosity

A 23-year-old woman with fever, oral ulcers, arthalgias and weight loss of 2-week duration suddenly developed blurred vision, with reduced visual acuity, cotton wool exudates and retinal vascular tortuosity. Laboratory testing revealed anaemia, lymphopaenia, positive antinuclear antibody and high anti-dsDNA antibody titre with low complement components. There was no evidence of infection, clinching the diagnosis of lupus retinopathy. Steroid therapy alone was highly effective and was also accompanied by a normalisation of haemoglobin and lymphocyte counts, after which azathioprine was added. Hydroxychloroquine was introduced after resolution of retinal changes. Immunosuppressive therapy was progressively tapered over the course of 12 months and then discontinued, and the patient remains in remission 48 months after the initial presentation. Our patient exemplifies a very rare manifestation of systemic lupus erythematosus. We emphasise the importance of its early detection and complexity of treatment in order to reduce visual morbidity.

scholarly journals Calcinosis cutis universalis - a rare manifestation of systemic lupus erthymatosus

2012 ◽  
Vol 16 (1) ◽  
pp. 22-23 ◽  
Author(s):  
Farhana Ebrahim Suleman ◽  
Mahmood Moosa tar mahomed Ally
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Rare Occurrence ◽  
Systemic Lupus ◽  
Calcinosis Cutis ◽  
Rare Manifestation ◽  
History Of ◽  
Rheumatic Conditions ◽  
Subcutaneous Calcification

Calcinosis cutis (or skin and subcutaneous calcification) is a feature of a variety of rheumatic conditions, most commonly dermatomyositis and scleroderma, but is rarely reported in systemic lupus erythematosus (SLE ). When calcinosis cutis does occur in patients with SLE, it tends to be localized (circumscripta) rather than generalized (universalis). We report a case of a 21 year old female who presented to us with a 6 year history of SLE and the rare occurrence of calcinosis cutis universalis.

scholarly journals Systemic Lupus Erythematosus Associated with Neurological Manifestations in a Border Collie Bitch

2021 ◽  
Vol 49 ◽  
Author(s):  
Isabel Rodrigues Rosado ◽  
Julia Perinotto Picelli ◽  
Juliana Gonzaga da Silva ◽  
Marina Cazarini Madeira ◽  
Taís Teixeira Zambarda ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Urinary Incontinence ◽  
Lupus Erythematosus ◽  
Clinical Signs ◽  
Neurological Manifestations ◽  
Systemic Lupus ◽  
Cutaneous Lesions ◽  
Cutaneous Manifestations ◽  
Immune Mediated ◽  
History Of

Background: Systemic lupus erythematosus (SLE) is an immune-mediated and multisystemic disorder which etiology is believed to be multifactorial. Its clinical signs vary accordingly to affected organs, cutaneous lesions being the most frequently observed. There are few reports of SLE in dogs with neurological manifestations. Therefore, the aim of this report is to describe a case of SLE in a dog with indicative signs of nervous system involvement.Case: A 6-year-old Border Collie bitch was referred to the Veterinary Hospital (HVU) of the University of Uberaba (UNIUBE) with a history of  with cluster seizures, inappetence and urinary incontinence. Erythema and flaking of nasal plan were noted on physical examination, and splenomegaly on abdominal palpation. Thrombocytopenia and slightly increased ALT were found on blood tests. Ehrlichiosis was suspected and doxycycline was prescribed together with phenobarbital for the control of seizures. In the follow-up visit, the dog was still presenting urinary incontinence, thrombocytopenia and splenomegaly. Also, an ulcer on the nasal mucocutaneous junction was observed. The patient went through a neurological examination which indicated thalamocortical lesion. Cerebrospinal fluid samples were obtained for cytology, culture and canine distemper test, and serology tests for leishmaniasis, toxoplasmosis and neosporosis were done. No alterations were found in these exams. The histopathology of the nasal lesion was proceeded and showed results consistent with lupus erythematosus. It was prescribed a 15-day course of prednisolone at immunosuppressive dose. The patient showed clinical improvement with this treatment. Azathioprine was started along with gradual removal of prednisolone. After twenty days of discontinuation of this drug, the dog presented epileptic seizures, urinary incontinence, thrombocytopenia, increased ALT and worsened nasal lesion. Prednisolone at immunosuppressive dose was reintroduced and the dose of azathioprine, increased. One week past this, the patient showed inappetence and an extensive hematoma in the thoracic region. Lab exams confirmed drug-induced acute pancreatitis. All medications were interrupted, the patient was hospitalized, and treatment for pancreatitis was initiated, but the dog passed away.Discussion: For involving multiple body systems and for presenting varied clinical signs, diagnosing SLE can be challenging in clinical routine. The dog from this report was a Border Collie; this breed is considered to be predisposed to this disease. The animal had a history of being exposed to solar radiation for a large part of the day, had dyspigmentation of nasal plan and had no application of sunscreen, predisposing the occurrence of SLE. Neurological signs are uncommon in SLE, but the seizures and the urinary incontinence were the main reasons for the dog’s guardian to look for medical assistance. The suspicion for SLE was raised due to cutaneous manifestations and persistent thrombocytopenia along with splenomegaly. Histopathological findings are essential for diagnosing SLE, as well as antinuclear antibody tests. Nonetheless, due to financial limitations, this last test was not performed. Azathioprine is an immunomodulating drug largely used along with glucocorticoids when treating SLE; however, this medication is prone to induce side effects as the ones presented by the dog from this report. Therefore, it is concluded that SLE should be considered as a differential diagnosis in patients showing cutaneous, hematological, systemic and neurological manifestations, considering the variety of signs caused by this disorder.Keywords: seizures, dog, immune-mediated encephalopathy. Lúpus eritematoso sistêmico associado a manifestações neurológicas em cadela da raça Border CollieDescritores: crises epilépticas, cão, encefalopatia imunomediada.

Pincer Nail Deformity Associated with Systemic Lupus Erythematosus

2005 ◽  
Vol 9 (1) ◽  
pp. 2-5 ◽  
Author(s):  
Candace Majeski ◽  
Bruce Ritchie ◽  
Martin Giuffre ◽  
Gilles Lauzon
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Surgical Treatment ◽  
Lupus Erythematosus ◽  
Autoimmune Disorder ◽  
Daily Activities ◽  
Review Of The Literature ◽  
Systemic Lupus ◽  
Cutaneous Manifestations ◽  
Nail Deformity

Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder with various systemic and cutaneous manifestations. Nail abnormalities, including onycholysis, red lunulae, pitting, and ridging, have been seen in patients with the disorder. To our knowledge, however, pincer nail deformity has yet to be reported coincident with the onset of SLE. Objective: We report a case of pincer nail deformity subsequent to the development of SLE and describe surgical treatment of the deformed nails. This is followed by a review of the literature. Conclusion: Acquired pincer nail is a dystrophy with numerous reported causative associations, including psoriasis, tumors of the nail apparatus, tinea ungium, ß-blocker usage, and now SLE. Pain from the resulting constriction can interfere greatly with daily activities and can be debilitating to the extent of requiring therapy.

scholarly journals Atypical dermatophytosis in a case of systemic lupus erythematosus

2020 ◽  
Vol 11 (e) ◽  
pp. e165.1-e165.3
Author(s):  
Manjunath M Shenoy ◽  
Goutham Kilaru ◽  
Ashmiya Razak ◽  
Malcolm Pinto
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Cutaneous Lupus Erythematosus ◽  
Autoimmune Disorder ◽  
Laboratory Evaluation ◽  
Systemic Lupus ◽  
Cutaneous Manifestations ◽  
Therapeutic Implications ◽  
The Face ◽  
Erythematous Plaques

Systemic lupus erythematosus (SLE) is a multiorgan autoimmune connective tissue disease with many muco-cutaneous manifestations. We report a case of SLE on treatment presented with scaly erythematous plaques on the trunk and extremities and diffuse scaly erythematous macular lesions on the face resembling cutaneous lupus erythematosus. Laboratory evaluation established a diagnosis of tinea corporis with faciei. He responded to long term itraconazole therapy. This case focuses on the modification of tinea in an autoimmune disorder on immunosuppressive therapy and its therapeutic implications.

scholarly journals Invasive Aspergillosis Masquerading as Catastrophic Antiphospholipid Syndrome

2013 ◽  
Vol 22 (5) ◽  
pp. 448-451 ◽  
Author(s):  
Kathryn S. Robinett ◽  
Bethany Weiler ◽  
Avelino C. Verceles
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Invasive Aspergillosis ◽  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Signs And Symptoms ◽  
Subdural Hemorrhage ◽  
Systemic Lupus ◽  
Catastrophic Antiphospholipid Syndrome ◽  
Oral Ulcers ◽  
History Of

A 25-year-old woman with a history of systemic lupus erythematosus who was taking steroids came to the hospital because of vague signs and symptoms of weight loss, constipation, and oral ulcers. Multiorgan dysfunction developed, and catastrophic antiphospholipid syndrome was suspected. She was treated with an intravenous infusion of heparin, but she experienced a subdural hemorrhage and died on day 10 of the hospitalization. An autopsy revealed disseminated invasive aspergillosis. This case illustrates that invasive aspergillosis is a frequently missed diagnosis and should be part of the differential diagnosis for any patient who is immunosuppressed, including patients with autoimmune diseases such as systemic lupus erythematosus.

scholarly journals Systemic lupus erythematosus and melioidosis

2019 ◽  
Vol 12 (7) ◽  
pp. e229974
Author(s):  
Mohd Jazman Che Rahim ◽  
Nurashikin Mohammad ◽  
Muhammad Imran Kamaruddin ◽  
Wan Syamimee Wan Ghazali
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Immunosuppressive Treatment ◽  
Young Female ◽  
Progressive Dyspnoea ◽  
Systemic Lupus ◽  
Intravenous Cyclophosphamide ◽  
Oral Ulcers ◽  
Remarkable Recovery ◽  
History Of

We reported a case of a young female patient presented with sepsis and diagnosed with melioidosis and systemic lupus erythematosus (SLE) within the same admission. She presented with 1-week history of productive cough, progressive dyspnoea together with prolonged fever, arthralgia, rashes and oral ulcers. She had septicemic shock, respiratory failure requiring intubation and ventilation in intensive care unit and subsequently developed acute renal failure requiring haemodialysis. Antibiotics and immunosuppressive treatment including low-dose intravenous cyclophosphamide were commenced. She had a remarkable recovery and was discharged after 6 weeks. There was no evidence of active SLE or relapse of melioidosis during clinic follow-ups.

scholarly journals SLE presenting as DAH and relapsing as refractory retinitis

2020 ◽  
Vol 90 (3) ◽  
Author(s):  
Somya Ish ◽  
Deepa Sharma ◽  
Pranav Ish
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Renal Function ◽  
Mycophenolate Mofetil ◽  
Lupus Erythematosus ◽  
Joint Pain ◽  
Diffuse Alveolar Hemorrhage ◽  
Systemic Lupus ◽  
Oral Ulcers ◽  
History Of ◽  
One Year

Dear Editor, A 17-year-old boy, diagnosed with Systemic Lupus Erythematosus (SLE), presented to ophthalmology department with gradual painless diminution of vision in both eyes (right more than left). He had already received 6 pulses of cyclophosphamide and steroids at monthly intervals one year back for diffuse alveolar hemorrhage (DAH) and was on maintenance oral 40 mg prednisolone and 3 grams mycophenolate mofetil (MMF). There was no history of oliguria, skin rash, joint pain, oral ulcers, photosensitivity or any neurological deficit in this presentation. There was no proteinuria, hematuria or worsening of renal function.

scholarly journals Chylous Ascites and Pleural Transudate: Rare Presentations in Systemic Lupus Erythematosus in Old Age

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Guan-Liang Chen ◽  
Deng-Ho Yang ◽  
Wen-Hsiu Hsu
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Pleural Effusion ◽  
Lupus Erythematosus ◽  
Chylous Ascites ◽  
Autoimmune Disorder ◽  
Initial Presentation ◽  
Systemic Lupus ◽  
Abdominal Sonography ◽  
Oral Ulcers ◽  
Multiple Organs

Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder with involvement of multiple organs. Various forms of serositis, including pleural effusion, pericardial effusion, and ascites, may be found during the course of SLE. Peritoneal involvement by ascites is common in the initial presentation of SLE. However, chylous ascites is uncommon in SLE patients. Here, we describe a 93-year-old female with initial presentation of chylous ascites during SLE flares. Marked distention and an ovoid shape of the abdomen were observed. Shifting dullness and central tympanic sounds were found on percussion. Rales were heard in bilateral breathing sounds, multiple oral ulcers appeared in the oral cavity, and chest images showed bilateral pleural effusion. Abdominal sonography revealed moderate ascites and pleural effusion. Neither organisms nor malignant cells were revealed in the culture or cytology of ascites and pleural effusion. The diagnosis of SLE was arrived at by positive antinuclear antibody (ANA), discoid rash, oral ulcers, serositis (pleural effusion and ascites), and proteinuria. The patient received intravenous methylprednisolone 250 mg/day for three days. The pleural effusion resolved dramatically after steroid therapy and abdominal distention related to ascites formation subsided obviously.

scholarly journals Bullous Lupus: An Atypical Case of Refractory Disease in a Patient with Sulfa Allergy

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Maria Salgado Guerrero ◽  
Oscar Mena Miranda ◽  
Ana B. Arevalo ◽  
Nevena Barjaktarovic ◽  
Barbara Mendez
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
African American Woman ◽  
Severe Disease ◽  
American Woman ◽  
Autoimmune Disorder ◽  
Prior History ◽  
Systemic Lupus ◽  
Initial Manifestation ◽  
History Of

Bullous systemic lupus erythematosus (BSLE) is a rare cutaneous autoimmune disorder characterized by rapid, widespread vesiculobullous lesions in patients with Systemic Lupus Erythematosus (SLE). BSLE can present as the initial manifestation of SLE and may be a marker of severe disease. In this case report, we present a case of a 22-year-old African American woman with BSLE and impaired renal function with subsequent nephrotic range proteinuria concerning for lupus nephritis and autoimmune hemolytic anemia, refractory to systemic corticosteroids, immunoglobulin, and mycophenolate mofetil, requiring dapsone after careful desensitization due to prior history of angioedema with sulfa drugs. This case highlights the importance of the prompt recognition of BSLE as the initial manifestations of SLE and illustrates the association of BSLE with severe disease and the benefit of concomitant use of dapsone with corticosteroids and other immunosuppressant drugs, even in patients with a history of sulfa allergy.

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