CASE REPORT
The subject of this case study is a female patient who is 55 years old
and has been diagnosed with lupus for 20 years. Additionally, she has
been diagnosed with lupus nephritis for 14 years and has been receiving
intermittent treatment with immunosuppressive and corticosteroid
medications such as hydroxychloroquine, cyclosporine, mycophenolate
mofetil, and prednisolone in varying dosages. The aforementioned patient
had severe skin lesions in the form of two painful papules in the
anterior and lateral areas of the leg. These papules progressively
became larger and transformed into an ulcerated lesion with 5×5 cm
dimensions, and the center of the lesions was found to be necrotic
(Figure 1). Concomitant with the disease, the individual exhibited a
malar rash, small joint arthritis, and renal involvement.
The individual exhibiting these clinical manifestations was admitted to
the Rheumatology Department at Imam Reza Hospital in Tabriz, where,
based on following consultation with the medical team, the patient was
scheduled to undergo a skin biopsy as a means to pursue further
investigation. The dermatology team conducted a skin biopsy (Figure 2).
The biopsy’s pathology results showed skin tissue with compact
hyperkeratosis, acanthosis, associated with superficial dermal fibrosis
and intradermal neutrophilic abscess formation, and leukocytoclastic
vasculitis which was compatible with PG, in the early stage.
Initial results of laboratory blood tests revealed elevated levels of
erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Also,
levels of anti-dsDNA antibody increased. The levels of other blood test
parameters are shown in Table 1.
The patient was treated with pulse therapy of methylprednisolone (1g)
for 3 consecutive days and an injection of Cyclophosphamide (750mفg).
Subsequently, prednisolone dosage began tapering
gradually (40 mg) and Cyclophosphamide was injected monthly.
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