1984 Volume 7 Issue 4 Pages 240-246
Although systemic lupus erythematosus (SLE) is well recognized to be associated with systemic vascular lesions, histologically proven severe vasculitis of the skin has rarely been documented in SLE literature. We had the opportunity to observe a patient with SLE who developed leukocytoclastic vasculitis in the erythematous lesion. Since this condition has received little attention, we feel that the following case report may be of interest.
A 34-year-old woman was admitted to the hospital in July 1982 because of erythematous rashes on face, chest and both thighs.
This patient's illness began at the age of 27 when she had fever, polyarthralgia and proteinuria. She responded well to 60mg prednisolone given at another hospital. Since then, she was maintained on varing doses of corticosteroid, and had had episodes of fever, arthralgia, facial erythema, photosensitivity and hair loss. The diagnosis of SLE was made in 1978 on her first visit at our outpatient clinic, based on clinical manifestations and a positive antinuclear antibody, LE cells and hypocomplementemia.
She remained stable on 10mg prednisolone until July 1982 when erythematous eruptions appeared on both thighs accompanied by the flare-up of butterfly rash after going outdoors. The erythematous rashes, with burning, stinging and edema, soon spread over her thighs and anterior chest, followed by multiple shallow ulcerlations. She had no upper respiratory symptoms and received no particular medications.
On admission, laboratory examination revealed microscopic hematuria and granular casts in urinalysis, positive CRP, hypergammaglobulinemia, an elevated anti-DNA antibody and hypocomplementemia. The circulating immune complex was elevated to 24.6μg/ml. A biopsy specimen of an erythematous lesion on a thigh showed leukocytoclastic vasculitis in the dermis containing numerous polymorphonuclear leukocytes and nuclear debris. Fibrinoid degeneration of walls of a few vessels was also found. Immunofluorescent staining demonstrated positive fluorescence for IgM, Clq, C3 and fibrinogen in the small vessel walls. She was treated with 40mg prednisolone and skin lesions gradually healed, accompanied by an improvement in laboratory findings.
The leukocytoclastic vasculitis in this case was considered to be a manifestation of SLE, since the development of it was closely associated with exacerbation of SLE and no other apparent causes were found.
