Localized lupus panniculitis in the thigh: a case report
Keywords:
Lupus panniculitis, lupus erythematosus profundus, hydroxychloroquine, prednisoneAbstract
Abstract
Lupus panniculitis or lupus erythematosus profundus is an uncommon variant of chronic cutaneous lupus, which may present in isolation or associated with systemic or discoid lupus, and whose diagnosis represents a challenge especially in the absence of systemic manifestations or serological alterations. The objective of this study was to describe the clinical, diagnostic and therapeutic features of a case of lupus panniculitis localized in the thigh, with isolated and seronegative presentation. A comprehensive clinical evaluation, laboratory tests (complete blood count, ESR, CRP, hepatic and renal profile, antinuclear antibodies and other autoantibodies, complement C3 and C4) and skin biopsy with histopathological and direct immunofluorescence study were performed. A 38-year-old female patient with no relevant history is presented, who presented an erythematous plaque with firm non-tender subcutaneous nodules and skin atrophy on the left thigh of four months of evolution. Antinuclear antibodies and other autoantibodies were negative, while biopsy revealed lobular lymphocytic panniculitis with hyaline fat necrosis, mucin deposits and granular deposits of IgG and C3 at the dermoepidermal junction, compatible with lupus panniculitis. Treatment with hydroxychloroquine (200 mg/day) and prednisone (30 mg/day) resulted in improvement at 4 weeks and considerable remission at 3 months, with no adverse effects or recurrences. It is concluded that isolated and seronegative lupus panniculitis should be included in the differential diagnosis of subcutaneous lesions, skin biopsy is the fundamental diagnostic tool and early treatment is effective, therefore prolonged follow-up is recommended.
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