A case report of lupus erythematosus profundus

Introduction: Lupus Erythematosus Profundus/Panniculitis (LEP) is a rare type of Chronic Cutaneous Lupus Erythematosus (LECC), which represents 1-3% of the cases, and it is more frequent in females.
Case report: We present a case of a 56-year-old Caucasian lady who presented with a two-year history of a persistent painful and erythematous patch on her left thigh. She reported a fall over the same side two months earlier. On examination, there was a large, indurated, oedematous, erythematous-violaceous patch over the upper lateral aspect of her left thigh, which had a linear skin invagination of lipoatrophy in the top area of the lesion. She had no other skin lesions, and she occasionally had arthralgias on her hand joints. The differential diagnoses considered were Morphoea, Infectious or Traumatic Panniculitis, Subcutaneous panniculitis-like T-cell lymphoma (SPTL) and Lupus Erythematosus Profundus/Panniculitis (LEP). Complete laboratory tests were performed which disclosed normal blood cell counts, urinalysis, complements (C3, C4) and no renal dysfunction. Serological studies showed variable positive ANA results, and anti-RNP/Sm antibody and anti nucleosomes antibody were positive. Anti-ds-DNA antibody was negative. A deep skin biopsy of the lesion revealed the diagnosis of LEP. Initially, she failed to hydroxychloroquine. Hence, she was treated with one month of prednisolone, methotrexate, and topical tacrolimus 0,1%, with a satisfactory response after two months of therapy.
Conclusion: A strict follow-up of patients with LEP is required as 50% of them may develop Systemic Lupus Erythematosus. This patient presentation was unusual as it was localized only at a site of trauma.
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Dr. Maria Adriana Castrillon