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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