Lupus panniculitis: a rare bilateral and symmetrical manifestation of cutaneous lupus erythematosus in an adolescent girl

Agnes Rosarina Prita Sari; Paranita Ferronika; Hardyanto Soebono; Flandiana Yogianti

doi:10.4081/dr.2022.9515

Lupus panniculitis is included in the chronic cutaneous lupus erythematosus group. An 18-year-old female patient came with the complaint of lumps on her face. When she was 16 years old, the patient started to complain about lumps on her right lower arm. Lumps were observed on her left cheek and right chin during the ongoing treatment. Histopathology results showed lymphocyte infiltration in between lobular adipocyte with fibrotic and fat necrosis in the subcutis. Lupus panniculitis lesions in this patient were found both on her face and on her lower arms, which are not considered common predilection sites of lupus panniculitis. The skin lesion observed in this patient was also bilateral and symmetrical, which was a rare finding.

Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick's Dermatology in General Medicine. 9th ed. New York: McGraw-Hill Education; 2019.

Burns T, Breathnach S, Cox N, Griffiths C, eds. Rook's Textbook of Dermatology. Vol 1. Chichester: Wiley-Blackwell; 2010.

Thiruveedhula H, Kurapati A, Samanthula H, Bora MKR. Bilaterally symmetrical lupus profundus with livedo reticularis as a sole cutaneous manifestation in a case of systemic lupus erythematosus. Int J Res Dermatol 2020;6:795-7.

McCarty M, Jeffries M, Hansen R. Lupus erythematosus profundus presenting as morphea-like lesions involving bilateral malar areas of a 12-year-old Philippine male with a negative ANA. J Am Acad Dermatol 2011;64.

Massone C, Kodama K, Salmhofer W, et al. Lupus erythematosus panniculitis (lupus profundus): clinical, histopathological, and molecular analysis of nine cases. J Cutan Pathol 2005;32:396-404.

Kopp A, Buechler C, Neumeier M, et al. Innate immunity and adipocyte function: ligand-specific activation of multiple toll-like receptors modulates cytokine, adipokine, and chemokine secretion in adipocytes. Obesity 2009;17:648-56.

Kono DH, Haraldsson MK, Lawson BR, et al. Endosomal TLR signaling is required for anti-nucleic acid and rheumatoid factor autoantibodies in lupus. Proce Natl Acad Sci U S A 2009;106:12061-6.

Lafyatis R, York M, Marshak-Rothstein A. Antimalarial agents: closing the gate on toll-like receptors? Arthritis Rheum 2006;54:3068-70.

Barrat FJ, Coffman RL. Development of TLR inhibitors for the treatment of autoimmune diseases. Immunol Rev 2008;223:271-83.

Eastham AB, Liang CA, Femia AN, et al. Lupus erythematosus panniculitis–induced facial atrophy: effective treatment with poly-L-lactic acid and hyaluronic acid dermal fillers. J Am Acad Dermatol 2013;69:e260-2.

Vera-Lastra O, Medina G, Cruz-Dominguez MdP, et al. Human adjuvant disease induced by foreign substances: a new model of ASIA (Shoenfeld's syndrome). Lupus 2012;21:128-35.

Gupta K, Bhari N, Verma KK, Gupta S. Permanent injectable polyacrylamide hydrogel dermal filler for a large subcutaneous defect secondary to lupus panniculitis. Dermatol Surg 2017;43:152-4.

Lei H, Ma GE, Liu Z. Evaluation of repairing facial depression deformities secondary to lupus erythematosus panniculitis with autologous fat grafting. J Craniofac Surg 2016;27:1765-9.

Sari, A. R. P., Ferronika, P., Soebono, H., & Yogianti, F. (2022). Lupus panniculitis: a rare bilateral and symmetrical manifestation of cutaneous lupus erythematosus in an adolescent girl. Dermatology Reports, 15(1). https://doi.org/10.4081/dr.2022.9515