Волчанка, сер...

dok_zlo — 29.07.2024

A 29-year-old woman with a history of systemic lupus erythematosus presented to the dermatology clinic with a 2-week history of an itchy, painful rash on her nose and hands. The rash had first appeared 1 day after the weather had turned cold. The patient reported no sun exposure. The physical examination was notable for erythematous macules and papules with punched-out ulcers on the nose (Panel A). Scattered papules were seen on the palms, and edematous erythrocyanosis of the fingertips (Panel B) with ulcerations on the lateral aspects (Panel C) was noted. Blood tests were positive for antinuclear antibodies, anti–double-stranded DNA antibodies, rheumatoid factor, anti-Ro antibodies, and antiphospholipid antibodies, and hypergammaglobulinemia was present. Cryoglobulin and cold agglutinin testing was negative. Histopathological examination of a biopsy specimen of the right nasal sidewall revealed vacuolar interface dermatitis and perivascular lymphocytic infiltrate. A diagnosis of chilblain lupus erythematosus was made. Chilblain lupus erythematosus is an uncommon form of cutaneous lupus erythematosus. The inflammatory skin lesions are precipitated by exposure to cold and typically occur on the hands and feet; involvement of the nose is uncommon. Treatment with glucocorticoids, azathioprine, hydroxychloroquine, and nifedipine was initiated. Counseling regarding cold avoidance was also provided. At a 2-week follow-up visit, the skin lesions had abated.
Wei-Yao Wang, M.D. , and Ming-Chieh Lin, M.D.
Published July 24, 2024
N Engl J Med 2024;391: e6
DOI: 10.1056/NEJMicm2400724
VOL. 391 NO. 4

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