Tumid Lupus Erythematosus: A Rare and Distinctive Variant of Cutaneous Lupus Erythematosus Masquerading as Urticarial Vasculitis

Evan Liu,Robert P Daze,Summer Moon

doi:10.7759/cureus.8305

Evan Liu, Robert P Daze + Show 1 more

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https://doi.org/10.7759/cureus.8305

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Abstract

Tumid lupus erythematosus (TLE) is a rare form of chronic cutaneous lupus that has triggered much debate regarding its clinical and histopathological features. It has been classically defined as annular erythematous, succulent, plaques involving the face and trunk that typically are devoid of any papulosquamous features such as scale and follicular plugging. These lesions are a clinical mimicker of other urticarial lesions such as urticarial vasculitis and lymphocytic infiltrate of Jessner. We report a case of TLE presenting in a 49-year-old Caucasian female whose initial clinical presentation was concerning for urticarial vasculitis due to presence of urticarial-like lesions present for approximately three months. Laboratory studies and histopathological correlations confirmed the diagnosis of TLE and the patient was successfully treated with topical corticosteroids.

Highlights

Tumid lupus erythematosus (TLE) is an uncommon variant of chronic cutaneous lupus erythematosus
We report a case of TLE presenting in a 49-yearold Caucasian female whose initial clinical presentation was concerning for urticarial vasculitis due to presence of urticarial-like lesions present for approximately three months
TLE may be a diagnostic challenge as it can be difficult to distinguish from lymphocytic infiltrate of Jessner and urticarial vasculitis

Summary

Introduction

Tumid lupus erythematosus (TLE) is an uncommon variant of chronic cutaneous lupus erythematosus It is characterized by photosensitive, erythematous, and edematous lesions affecting the head, neck, and trunk [1]. A 49-year-old Caucasian female with a past medical history of cutaneous squamous cell carcinoma and history of smoking tobacco use presented for evaluation of a pruritic rash on her back that had been present for approximately three months She was clinically diagnosed with urticaria and initially treated with flurandrenolide 0.05% cream for two weeks with minimal improvement. Two 4-mm punch biopsies from lesions were taken from two different sites They both demonstrated a superficial and deep perivascular and periadnexal lymphocytic infiltrate, dermal mucin, and edema (Figures 3-4).

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