Acute Generalized Cutaneous Lupus Erythematosus Repeatedly Mistaken for Cellulitis

Area of Science:

• Dermatology
• Rheumatology
• Nephrology

Background:

• Cutaneous lupus erythematosus (CLE) can manifest independently or alongside systemic lupus erythematosus (SLE).
• Acute cutaneous lupus erythematosus (ACLE) shows a strong association with SLE, necessitating thorough evaluation for systemic disease.
• Undiagnosed or complex systemic lupus erythematosus can complicate the presentation and diagnosis of cutaneous manifestations.

Observation:

• A 52-year-old female with a history suggestive of undiagnosed systemic lupus erythematosus (SLE), including end-stage renal disease, antiphospholipid syndrome, and seizures, presented with an unusual manifestation of acute cutaneous lupus erythematosus (ACLE).
• The patient's significant and complex medical history, coupled with an atypical ACLE presentation, led to initial diagnostic challenges.
• Despite the high association between ACLE and SLE, the diagnosis was initially overlooked due to the unusual presentation and the patient's prolonged undiagnosed status.

Findings:

• The case underscores that acute cutaneous lupus erythematosus (ACLE) is a critical indicator for systemic lupus erythematosus (SLE) evaluation.
• An unusual presentation of ACLE in a patient with a history consistent with SLE can be easily overlooked, delaying diagnosis.
• Prompt recognition of ACLE's association with SLE is crucial for timely diagnosis and management of systemic disease.

Implications:

• Healthcare providers should maintain a high index of suspicion for systemic lupus erythematosus (SLE) in patients presenting with acute cutaneous lupus erythematosus (ACLE), irrespective of atypical features.
• Comprehensive workups for systemic lupus erythematosus (SLE) are essential when acute cutaneous lupus erythematosus (ACLE) is diagnosed, particularly in patients with complex or undiagnosed histories.
• This case emphasizes the need for integrated diagnostic approaches in dermatology and rheumatology to ensure accurate and timely diagnosis of systemic lupus erythematosus (SLE).