Abstract
Tumid lupus erythematosus (TLE) is a rare variant of cutaneous lupus erythematosus. Clinically, it lacks typical changes found in discoid lupus and antinuclear antibodies (ANA) levels are elevated in only 10% of the patients. Coexistent systemic lupus erythematosus (SLE) has been reported to be rare, and literature shows only a few case reports. We present a case of coexistent tumid lupus and SLE. We present a case of a 48-year-old Caucasian female who presented with chronic facial rash, photosensitivity, intermittent oral ulcers, joint pain with morning stiffness, and unintentional weight loss. Laboratory studies showed positive ANA at 1:640, elevated erythrocyte sedimentation rate, positive anticardiolipin immunoglobulin (Ig) G, anticardiolipin IgM, and anti-beta-2 glycoprotein IgM. Skin biopsy of the rash showed a superficial and deep dense lymphocytic infiltrate with mucin deposition, histopathology favoring tumid lupus. The patient was diagnosed with TLE with SLE and was started on hydroxychloroquine with improvement in her rash. Ultraviolet light and certain medications have been proven to play a role in the pathogenesis of tumid lupus. It usually responds to photoprotection, topical treatment, or oral antimalarial therapy.
Highlights
Tumid lupus erythematosus, or lupus erythematosus tumidus, is a rare form of chronic cutaneous lupus erythematosus
We present a case of tumid lupus erythematosus, eventually developing systemic lupus erythematosus, with positive antinuclear antibodies (ANA)
About 70% of tumid lupus erythematosus lesions are associated with photosensitivity, which is a common characteristic of cutaneous lesions of systemic lupus erythematosus
Summary
Lupus erythematosus tumidus, is a rare form of chronic cutaneous lupus erythematosus. The histopathology of tumid lupus erythematosus comprises of a superficial and deep dense lymphocytic infiltrate in the perivascular and periadnexal regions, diffuse mucin deposition, and unaltered basement membrane. The patient reported a history of hair loss, intermittent oral ulcers, photosensitivity, unintentional weight loss (10 pounds in one year), and arthralgias She did not have any history of Raynaud’s phenomenon, history of thromboembolic events, hematuria, pleurisy, and pleural or pericardial effusions. Other less likely but considered differentials were Jessner’s lymphocytic infiltrations, polymorphous light eruption, pseudolymphoma, and plaque mucinosis With her symptoms and signs of photosensitivity, oral ulcers, positive ANA, positive antiphospholipid antibodies, and abnormal serum level of IgG or IgM anticardiolipin antibodies, she was classified with systemic lupus erythematosus [5]. The patient was started on hydroxychloroquine sulfate 200 mg daily and continued on triamcinolone acetonide 0.1% topical cream daily with the resolution of the rash, and improvement in oral ulcers and arthralgias within three months
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