Living in the Darkness
Format
Poster
Start Date
6-11-2020 12:45 PM
End Date
6-11-2020 1:00 PM
Abstract
Joel Brooks Tamayo Joel, MD, Internal Medicine, Kendall Regional Medical Center. Daniel Gonzalez, MD, Internal Medicine, Kendall Regional Medical Center. Tarig Elhakim, MD, Internal Medicine, Kendall Regional Medical Center. Ana Suarez, MD, Internal Medicine, Kendall Regional Medical Center. Yoandy Rodriguez Fuentes, MD, faculty. Vanina Molinares, MD, APD. Roberto Ruiz, MD, faculty Cutaneous lupus erythematosus comprises a wide-ranging of dermatologic manifestations and classified into several subtypes, including acute cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus (SCLE), and chronic cutaneous lupus erythematosus. Case report This is a 52-year-old female with past medical history significant for RA who presented complaining of skin eruption, on the face, chest, upper torso and dorsum of the hands. Serology: elevated ESR, SS-A/Ro and positive ANA. Anti-DS-DNA WNL. Low C3 and C4 complement. Skin biopsy showed no S-J changes present. Sub corneal bulla, epidermal atrophy. Direct immunofluorescence of skin biopsy revealed a fine granular IgG deposition along the epidermal-dermal junction. Discussion SCLE occurs primarily in middle-aged women. SCLE is highly photosensitive. There are two morphologic variants of SCLE: annular and polycyclic photosensitivity plaques. Patients with SCLE usually have only mild systemic symptoms, mainly arthritis and myalgias. Serology, 70% of SCLE patients are anti-Ro (SS-A) positive. A multicenter study found 70-80% of SCLE patients were ANA positive, and only 5% had anti-dsDNA. The presence of IgG deposits is a highly specific finding in SCLE. Therapy includes hydrochloroquine, methotrexate, and cyclosporine and combination therapy. Patients should avoid sun exposure and use barrier protection and sunscreen. Conclusions SCLEs is an autoimmune disease and the diagnosis is mainly clinical. Confirmatory histopathologic examination with skin biopsy is indicated when the diagnosis is unclear. Laboratory studies like anti-SSA/Ro and ANA are also recommended as well. Direct immunofluorescence with granular pattern of deposition of immunoglobulin at the epidermal-dermal junction supports the diagnosis. Key words: subcutaneous, lupus, photosensitivity
Living in the Darkness
Joel Brooks Tamayo Joel, MD, Internal Medicine, Kendall Regional Medical Center. Daniel Gonzalez, MD, Internal Medicine, Kendall Regional Medical Center. Tarig Elhakim, MD, Internal Medicine, Kendall Regional Medical Center. Ana Suarez, MD, Internal Medicine, Kendall Regional Medical Center. Yoandy Rodriguez Fuentes, MD, faculty. Vanina Molinares, MD, APD. Roberto Ruiz, MD, faculty Cutaneous lupus erythematosus comprises a wide-ranging of dermatologic manifestations and classified into several subtypes, including acute cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus (SCLE), and chronic cutaneous lupus erythematosus. Case report This is a 52-year-old female with past medical history significant for RA who presented complaining of skin eruption, on the face, chest, upper torso and dorsum of the hands. Serology: elevated ESR, SS-A/Ro and positive ANA. Anti-DS-DNA WNL. Low C3 and C4 complement. Skin biopsy showed no S-J changes present. Sub corneal bulla, epidermal atrophy. Direct immunofluorescence of skin biopsy revealed a fine granular IgG deposition along the epidermal-dermal junction. Discussion SCLE occurs primarily in middle-aged women. SCLE is highly photosensitive. There are two morphologic variants of SCLE: annular and polycyclic photosensitivity plaques. Patients with SCLE usually have only mild systemic symptoms, mainly arthritis and myalgias. Serology, 70% of SCLE patients are anti-Ro (SS-A) positive. A multicenter study found 70-80% of SCLE patients were ANA positive, and only 5% had anti-dsDNA. The presence of IgG deposits is a highly specific finding in SCLE. Therapy includes hydrochloroquine, methotrexate, and cyclosporine and combination therapy. Patients should avoid sun exposure and use barrier protection and sunscreen. Conclusions SCLEs is an autoimmune disease and the diagnosis is mainly clinical. Confirmatory histopathologic examination with skin biopsy is indicated when the diagnosis is unclear. Laboratory studies like anti-SSA/Ro and ANA are also recommended as well. Direct immunofluorescence with granular pattern of deposition of immunoglobulin at the epidermal-dermal junction supports the diagnosis. Key words: subcutaneous, lupus, photosensitivity