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Systemic lupus erythematosus presenting as erythema annulare centrifugum R Chander, P Yadav, A Singh and A Nangia Lupus published online 6 May 2014 DOI: 10.1177/0961203314534302 The online version of this article can be found at: http://lup.sagepub.com/content/early/2014/05/03/0961203314534302
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CASE REPORT
Systemic lupus erythematosus presenting as erythema annulare centrifugum R Chander1, P Yadav1, A Singh1 and A Nangia2 1
Department of Dermatology and Sexually Transmitted Diseases, Lady Hardinge Medical College and Suchita Kriplani Hospital, Delhi, India; and 2Department of Pathology, Lady Hardinge Medical College and Suchita Kriplani Hospital, Delhi, India
A case of systemic lupus erythematosus presenting as erythema annulare centrifugum involving atypical sites (face, palm and sole) and raised serum angiotensin-converting enzyme levels has been illustrated. Lupus (2014) 0, 1–4. Key words: Systemic lupus erythematosus; erythema annulare centrifugum
Introduction Erythema annulare centrifugum (EAC) is classified as a gyrate or annular erythema which characteristically presents as an annular erythematous plaque with a trailing scale. It is a clinical reaction pattern with varying etiologies ranging from bacterial and viral infections to drugs, lupus erythematosus (LE), malignancies, etc. Though EAC histopathologically characterized as tumid LE is relatively common, initial presentation of systemic lupus erythematosus (SLE) as EAC is rarely reported. Herein, we describe the case of a 20-year-old female presenting with EAC involving atypical sites, who on further evaluation was diagnosed to have SLE.
Case report A 20-year-old female presented with multiple erythematous annular plaques with fine marginal scaling and central clearing over the face as well as both palms and soles over 2 months associated with slight itching. (Figures 1–3). She had experienced a similar episode involving the face, scalp and trunk 2 years previously which healed with topical medication leaving behind hyperpigmentation. Both episodes presented during the summer period and were associated with photoaggravation. Correspondence to: Pravesh Yadav, RZ-97, Phase-III, Prem Nagar, Najafgarh, New Delhi-110043, India. Email: [email protected] Received 24 September 2013; accepted 9 April 2014
She also had recurrent high-grade fever associated with severe headache and malaise since the first episode. She also admitted having recurrent oral ulcerations, photosensitivity and diffuse hair loss for 2 years. There was no history of joint pains, dyspnea, chest pain, gastrointestinal or urinary complaints and thromboembolic events. She had no menstrual irregularities or sleep disturbances. There was no significant family history. General physical examination was within normal limits except for pallor and pedal edema. Hematological examination revealed bicytopenic anemia. Her hemoglobin (6.9 gm/dl) and total leucocyte count (3100/cu mm) were low. Reticulocyte count was 1.8%. Peripheral smear showed microcytic hypochromic anemia, along with target cells; however, there was no evidence of hemolysis. Erythrocyte sedimentation rate was raised (104 mm in the first hour); C-reactive protein and rheumatoid factor were positive. Further, hematological evaluation revealed low serum ferritin (8.8 ng/ml). Serum iron (144 ng/dl) and total iron binding capacity (351 ng/dl) were, however, normal. Serum vitamin B12 (
http://lup.sagepub.com/
Systemic lupus erythematosus presenting as erythema annulare centrifugum R Chander, P Yadav, A Singh and A Nangia Lupus published online 6 May 2014 DOI: 10.1177/0961203314534302 The online version of this article can be found at: http://lup.sagepub.com/content/early/2014/05/03/0961203314534302
Published by: http://www.sagepublications.com
Additional services and information for Lupus can be found at: Email Alerts: http://lup.sagepub.com/cgi/alerts Subscriptions: http://lup.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> OnlineFirst Version of Record - May 6, 2014 What is This?
Downloaded from lup.sagepub.com at UNIV OF PITTSBURGH on May 31, 2014
XML Template (2014) [2.5.2014–10:41am] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/LUPJ/Vol00000/140094/APPFile/SG-LUPJ140094.3d
(LUP)
[1–4] [PREPRINTER stage]
Lupus (2014) 0,
1–4
http://lup.sagepub.com
CASE REPORT
Systemic lupus erythematosus presenting as erythema annulare centrifugum R Chander1, P Yadav1, A Singh1 and A Nangia2 1
Department of Dermatology and Sexually Transmitted Diseases, Lady Hardinge Medical College and Suchita Kriplani Hospital, Delhi, India; and 2Department of Pathology, Lady Hardinge Medical College and Suchita Kriplani Hospital, Delhi, India
A case of systemic lupus erythematosus presenting as erythema annulare centrifugum involving atypical sites (face, palm and sole) and raised serum angiotensin-converting enzyme levels has been illustrated. Lupus (2014) 0, 1–4. Key words: Systemic lupus erythematosus; erythema annulare centrifugum
Introduction Erythema annulare centrifugum (EAC) is classified as a gyrate or annular erythema which characteristically presents as an annular erythematous plaque with a trailing scale. It is a clinical reaction pattern with varying etiologies ranging from bacterial and viral infections to drugs, lupus erythematosus (LE), malignancies, etc. Though EAC histopathologically characterized as tumid LE is relatively common, initial presentation of systemic lupus erythematosus (SLE) as EAC is rarely reported. Herein, we describe the case of a 20-year-old female presenting with EAC involving atypical sites, who on further evaluation was diagnosed to have SLE.
Case report A 20-year-old female presented with multiple erythematous annular plaques with fine marginal scaling and central clearing over the face as well as both palms and soles over 2 months associated with slight itching. (Figures 1–3). She had experienced a similar episode involving the face, scalp and trunk 2 years previously which healed with topical medication leaving behind hyperpigmentation. Both episodes presented during the summer period and were associated with photoaggravation. Correspondence to: Pravesh Yadav, RZ-97, Phase-III, Prem Nagar, Najafgarh, New Delhi-110043, India. Email: [email protected] Received 24 September 2013; accepted 9 April 2014
She also had recurrent high-grade fever associated with severe headache and malaise since the first episode. She also admitted having recurrent oral ulcerations, photosensitivity and diffuse hair loss for 2 years. There was no history of joint pains, dyspnea, chest pain, gastrointestinal or urinary complaints and thromboembolic events. She had no menstrual irregularities or sleep disturbances. There was no significant family history. General physical examination was within normal limits except for pallor and pedal edema. Hematological examination revealed bicytopenic anemia. Her hemoglobin (6.9 gm/dl) and total leucocyte count (3100/cu mm) were low. Reticulocyte count was 1.8%. Peripheral smear showed microcytic hypochromic anemia, along with target cells; however, there was no evidence of hemolysis. Erythrocyte sedimentation rate was raised (104 mm in the first hour); C-reactive protein and rheumatoid factor were positive. Further, hematological evaluation revealed low serum ferritin (8.8 ng/ml). Serum iron (144 ng/dl) and total iron binding capacity (351 ng/dl) were, however, normal. Serum vitamin B12 (
