A Case Report of a Male with Systemic Lupus Erythematous with First Presentation of Annular Macular Itchy Rashes on his Extremities

Abstract

Background: Systemic lupus erythematosus (SLE) is an idiopathic autoimmune disease which impacts multiple organs and has various clinical presentations. Among all the organs, the skin is the most frequently affected.

Case Presentation: This case report presents a 34-year-old male who presented with severe, itchy, and painful rashes over his right arm and both legs, along with a history of pigmented skin lesions. Initially, the patient was given corticosteroid creams by a dermatologist, but the condition progressed, requiring further investigation. The patient's medical history revealed hypertension and, on review, signs of rashes, fatigue, and arthralgias were noted.

Physical examination indicated mild swelling and tenderness in both knees. Additionally, an examination revealed his skin was warm, he had fast capillary refill (<2 seconds), and he had an erythematic rash on the right arm and both legs. A nodular erythema rash was seen on the left leg, along with pigmented skin lesions on the right leg, including a bigger lesion measuring approximately 2.5 cm. Laboratory results indicated increased creatinine, low white blood cell count, anemia, and abnormal protein levels, raising doubts about SLE. Further tests confirmed a raised level of autoantibodies, low complement levels, and positive lupus-related antibodies.

Later, the patient was referred to a rheumatologist and an SLE diagnosis was confirmed based on laboratory results and hematological manifestations, mucocutaneous involvement, and lupus nephritis. Treatment initially started with hydroxychloroquine and prednisolone, then tests were repeated and the patient underwent a renal biopsy that revealed focal segmental glomerulosclerosis. He was again prescribed methylprednisolone and prednisolone for three days. The patient's condition resolved and he made a successful recovery.

Conclusion: This case demonstrates the multiple clinical manifestations of SLE, the necessity of in-depth investigations, and the requirement for multidisciplinary care to address the intricacies of organ involvement in the disease.