 |
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2019, vol. 25, issue1
Subject Area: Medicine
-
DOI: 10.5272/jimab.2019251.2443
Published online: 22 March 2019
Case report
J of IMAB. 2019 Jan-Mar;25(1):2443-2446
LUPUS VASCULITIS
Desislava Tsvetanova1
, Ivelina Yordanova1, Hristina Haidudova1, Klimentina Gospodinova1, Verka Pavlova1, Maya Alexieva1, Milen Karaivanov2, Dimitar Gospodinov1,
1) Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University-Pleven, Bulgaria.
2) Department of Pathoanatomy, Faculty of Medicine, Medical University - Pleven, Bulgaria.
ABSTRACT:
Combination between Leucocytoclastic vasculitis and Subacute cutaneous lupus erythematosus has been only rarely reported in the literature. Pathological cutaneous lesions are presented by purpura, erythematous macules, urticarial, nodules and necroses.We present a 58-year-old woman with painful nodular lesions on the left thigh.The disease started in June 2015 with photosensitivity and psoriasiform rashes on the back. Pathological cutaneous changes affected lateral and dorsal surface of the left thigh. It was presented by painful, indurated in base, ulcerative plaques, with unclear borders and necrotic surface. There were no deviations from complete blood count and biochemistry. Immunological investigations revealed elevated levels of MPO(рАNCA) – 1.38 U/ml, antinuclear antibodies (ANA)- 134.1 U/ml, SS-A(Ro) antibodies – 233.7 U/ml CRP- 12.7mg/l. Urine analysis revealed positive protein results.Escherichia coli was isolated from microbiology testing. Histopathological result from ulcerative lesions from the left thigh of the patient revealed necrotizing leukocytoclastic vasculitis. The result from direct immunofluorescence microscopy of lesional skin corresponded to lupus erythematosus.The diagnosis lupus vasculitis was made. Systemic therapy with chloroquine phosphate, methylprednisolone, methotrexate was administered. Topical treatment included proteolytic enzyme in dressings and vacuum therapy with good effect.
Keywords: Lupus vasculitis, antinuclear antibodies (ANA), SS-A(Ro) antibodies, vacuum therapy, chloroquine phosphate, methylprednisolone, methotrexate,
- Download FULL TEXT /PDF 1800 KB/
Please cite this article as: Tsvetanova D, Yordanova I, Haidudova H, Gospodinova K, Pavlova V, Alexieva M, Karaivanov M, Gospodinov D. Lupus vasculitis. J of IMAB. 2019 Jan-Mar;25(1):2443-2446. DOI: 10.5272/jimab.2019251.2443
Correspondence to: Desislava Tsvetanova, Department of Dermatology, venereology and allergology, Medical Universisty Pleven, Bulgaria; 91, Gen. Vladimir Vazov str., Pleven, Bulgaria; E-mail: desi_tzvetanova@abv.bg
REFERENCES:
1. Sanchez-Perez J, Penas PF, Ríos-Buceta L, Fernandez-Herrera J, Fraga J, García-Díez A.Leukocytoclastic vasculitis in subacute cutaneous lupus erythematosus: clinicopathologic study of three cases and review of the literature. Dermatology. 1996;193(3):230-5. [PubMed] [Crossref]
2. Sontheimer RD, Thomas JR, Gilliam JN. Subacute cutaneous lupus erythematosus: a cutaneous marker for a distinct lupus erythematosus subset. Arch Dermatol. 1979 Dec;115(12):1409-15. [PubMed]
3. Gronhagen CM, Nyberg F. Cutaneous lupus erythematosus: An update. Indian Dermatol Online J.2014 Jan;5(1):7-13. [PubMed] [Crossref]
4. Berti S, Moretti S, Lucin C, Amato L, Massi D, Fabbri P.Urticarial vasculitis and subacute cutaneous lupus erythematosus. Lupus. 2005;14(6):489-92. [PubMed] [Crossref]
5. Sontheimer RD. Subacute cutaneous lupus erythematosus: a decade’s perspective. Med Clin North Am. 1989 Sep;73(5):1073-90.
6. Watson RM, Talwar P, Alexander E, Bias WB, Provost TT. Subacute cutaneous lupus erythematosus-immunogenetic associations. J Autoimmunity. 1991;4(1):73-85.
7. Fabbri P, Cardinali C, Giomi B, Caproni M.Cutaneous lupus erythematosus Diagnosis and management. Am J Clin Dermatol. 2003; 4(7):449-65. [PubMed] [Crossref]
8. Cribier B, Couilliet D, Meyer P, Grosshans E. The severity of histopathological changes of leukocytoclastic vasculitis is not predictive of extracutaneous involvement.Am J Dermatopathol. 1999 Dec;21(6):532-6. [PubMed]
9. Duna GF, Cash JM. Treatment of refractory cutaneous lupus erythematosus. Rheum Dis Clin North Am. 1995 Feb;21(1):99-115. [PubMed]
10. Callen JP, Spencer LV, Burruss JB,Holtman J.Azathioprine an effective, corticosteroid-sparing therapy for patients with recalcitrant cutaneous lupus erythematosus or with recalcitrant cutaneous leukocytoclastic vasculitis. Arch Dermatol.1991 Apr;127(4):515-22
11. Stevens RJ, Andujar C, Edwards CJ, Ames PR, Barwick AR, KhamashtaMA, et al.Thalidomide in the treatment of the cutaneous manifestations of lupus erythematosus: experience in sixteen consecutive patients. Br J Rheumatol. 1997 Mar;36(3):353-59. [PubMed]
12. Zutt M, Haas E, Kruger U, Distler M, Neumann C. Successful use of vacuum-assisted closure therapy for leg ulcers caused by occluding vasculopathy and inflammatory vascular diseases--a case series. Dermatology. 2007;214(4):319-24. [PubMed] [Crossref]
Received: 12 November 2018
Published online: 22 March 2019