Subacute cutaneous lupus erythematosus, erythema multiforme type - case report

Abstract

Within cutaneous lupus erythematosus, the subacute form (SCLE) represents a clinically, serologically and genetically distinct subtype. The frequency of SCLE ranges from 7 to 27% of clinical forms seen in patients diagnosed with cutaneous lupus erythematosus [1]. Clinically it manifests as erythematous macules/ papules that progress to papulosquamous or annular/polyclic plaques located at the photoexposed areas. SCLE may start with several typical clinical forms: erythema multiforme, exfoliative erythroderma, pityriasiform and exanthematous. Diagnosis includes clinical manifestations and the presence of anti-Ro/SS-A and less frequently anti-La/SS-B antibodies. Treatment of subacute cutaneous lupus erythematosus is based on antimalarials, glucocorticosteroids used per os and topically. Aim: To highlight the clinical and evolutive particularities in SCLE, erythema multiforme type. Materials and methods Patient, aged 33 years, assisted in the Dermatology Department for persistence of skin lesions for about 3 years, which started on photoexposed areas, subfebrile. The previously established diagnosis was erythema multiforme minor type, due to multiple erythemato-papular lesions attested on the forearms and arms, rapidly extensive, well defined, oval, purpuric, centrally depressed, with reddish periphery, slightly pruritic. The treatment administered proved ineffective. Evolutive the patient’s condition worsened by the appearance of new, paresthenic and intensely pruritic eruptions. Clinical examination revealed acute, inflammatory, disseminated, polymorphous skin lesions. The anterior and posterior photoexposed trunk, arms and forearms showed well-defined plaques with preserved skin grid, erythematous margins and reddish-brown peripheral halo, and perilesional the presence of solitary inflammatory papules. The eruptions are accompanied by modest pruritus and itching. Paraclinically: glucose 6.6 mmol/l; CRP ++++; blood summary lymphocytosis and moderate granulocytopenia; SS-A intensely positive; Ro-52 equivocal; SS-B intensely positive; Treatment with systemic and topical glucocorticosteroids as well as antimalarials led to an obvious remission of the skin lesions. Discussion Correct diagnosis of subacute cutaneous lupus erythematosus is associated with the need to know the possible onset variants. The positive diagnosis is based on clinical manifestations characteristic of the disease, and is a conclusive one in the case of erythema multiforme type in photoexposed areas, in association with specific paraclinical changes anti-Ro/SS-A (70-90%) and anti-La/SS-B (30-50%) [2]. Conclusions The particularities of the presented case consist in the appearance of erythema multiforme -like skin manifestations at the onset, which initially mimicked the respective disease. The presence of specific clinical signs, associated with intensely positive anti-Ro/SS-A and anti-La/SS-B paraclinical data, deducted the diagnosis of subacute cutaneous lupus erythematosus. The prognosis is more reserved if SCLE evolves with systemic manifestations.