[Development of "mixed connective tissue disease" (MCTD) from discoid lupus erythematosus]

A patient with discoid lupus erythematosus is reported which turned into a mixed connective tissue disease (MCTD) within five months. THe patient developed a severe polysymptomatic clinical picture with frailty, myositis, generalized erythema and livedo racemosa features, but without renal involvement. Combined therapy with prednisolone and azathioprine led to rapid regression of all symptoms. After releasing from the hospital a mitigated relapse could be controlled by increasing the dose of cortico-steroids. No other relapse occurred during the following year. Since the onset of disease the indirect immunofluorescence showed antinuclear antibodies of the speckled pattern. Also we could mark antibodies against ENA. We regard this finding as an indication, that in patients with discoid lupus erythematosus and antinuclear antibodies of the speckled pattern the risk of progressing into MCTD had to be considered. Repeated controls for symptoms of other collagenoses, therefore, should follow for a period of two years.