Abstract
Cutaneous manifestations are second most common presenting feature of lupus. Discoid lupus erythematosus is the most common variant amongst all; lupus panniculitis being described in only 2-5% of cases. Most cases of cutaneous lupus are associated with autoantibodies and either precede or follow the systemic manifestations of lupus. There is no proven treatment for cutaneous manifestations of lupus including lupus panniculitis. Available non-randomized studies show efficacy of hydroxychoroquine in most cases, whereas methotrexate and other immunosuppressant are used in relapsing cases. We describe a case of lupus panniculitis presenting as isolated manifestation of lupus with negative autoantibody titers which responded well to methotrexate. We observed that lesions went into drug free remission in 1 year and did not recur on 1 year follow-up. There was no residual skin atrophy or scarring. Drug free remission in isolated cases of lupus panniculitis variant could be possible with timely intervention in the absence of autoantibodies. Keywords: lupus; Methotrexate; Nepal; panniculitis.
Highlights
Cutaneous manifestations are the second most common presenting feature of systemic lupus erythematosus (SLE).[1]
We describe a case of lupus panniculitis presenting as isolated manifestation of lupus with negative autoantibody titers which responded well to methotrexate
We describe a case of young female with isolated lupus panniculitis who had sustained drug free remission with methotrexate
Summary
Cutaneous manifestations are the second most common presenting feature of systemic lupus erythematosus (SLE).[1]. We describe a case of young female with isolated lupus panniculitis who had sustained drug free remission with methotrexate. The lesions appeared as confluent areas of erythema and induration with superficial ulceration. She denied any history of previous trauma, surgery, insect bite or chemical exposure. Vaidya et al Sustained Drug Free Remission of Lupus Panniculitis with Methotrexate: A Case Report From Nepal (ANA) was positive in low titres (1:80 speckled) and extractable nuclear antigens (ENA) were absent; anticardiolipin IgG/IgM and lupus anti-coagulant were negative (Table 2); erythrocyte sedimentation rate (ESR) by Westergren’s method was 42mm in 1st hour and C-reactive protein (CRP) was 36.4 mg/L. Confluent areas of erythema and induration with superficial ulceration on left arm of the patient at presentation
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