Systemic lupus erythematosus in a patient with refractory anemia

A 69-year-old man was diagnosed as having refractory anemia (RA), accompanied by pancytopenia of two years' duration, myelodysplasia in all three cell lines, abnormal karyotype of 46, XY, 20q--in bone marrow cells, and positive antinuclear and DNA antibody tests. One year after his first visit, he developed arthritis and maculopapular erythematous rashes. The histologic features of the skin lesions were similar to those of in discoid lupus erythematosus. He was diagnosed as having systemic lupus erythematosus supervening refractory anemia.