A case report of lupus erythematosus tumidus converted from discoid lupus erythematosus.

RATIONALE

Lupus erythematosus tumidus (LET) is an uncommon type of cutaneous lupus erythematosus (CLE) that is rarely associated with other forms of lupus erythematosus.

PATIENT CONCERNS

We report a 62-year-old Chinese man presented with recurrent erythematous facial plaques for 1 year and a low-grade fever for 1 week. He had been diagnosed as discoid lupus erythematosus (DLE) 1 year before. Physical examination showed diverse lesions, including prominent swelling of the eyelids, a few erythematous, edematous plaques on the left forehead, face, and neck, and 2 hairless macules. The histopathologic findings reveal liquefaction degeneration of the basal cells, perivascular, and periadnexal infiltration of lymphocytes, and interstitial mucin deposition in the superficial, and deep dermis.

DIAGNOSES

A diagnosis of LET was made on clinical and histological features.

INTERVENTIONS

The patient started treatment with prednisolone (1 mg/kg. d), combined with hydroxychloroquine (200 mg twice daily), and topical tacrolimus.

OUTCOMES

The cutaneous lesions completely cleared after a period of 3 months. No adverse effects or clinical evidence of recurrence had been found during the 6-month follow-up period.

LESSONS

We report a case of LET converted from DLE with diverse lesions, unusual pathologic findings and slow response to the treatment of corticosteroids combined with hydroxychloroquine. We speculate that a continuous spectrum may include DLE, LET, and systemic lupus erythematosus (SLE), these 3 entities could potentially, convert between each other.