Atypical cutaneous findings in a patient with systemic lupus erythematosus.
A previously diagnosed systemic lupus erythematosus patient presented with arthralgia, skin rash and muscular weakness. When treated with high-dose corticosteroids and methotrexate she improved, except for a persistent lesion in the hand which evolved into a profound ulcer, along with tender subcutaneous nodules in the calf. A skin biopsy disclosed necrotizing vasculitis with giant cell granuloma revealing acid fast positive bacteria on ziels nilsen staining. A chest X-ray disclosed miliary tuberculosis (TB). The patient was diagnosed as miliary TB with prominent cutaneous involvement and treated with four anti-tuberculous drugs with slow resolution of her systemic, pulmonary and skin signs.
Elkayam
O
O
Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. oribe14@netvision.net.il
Gat
A
A
Lidgi
M
M
Segal
R
R
Yaron
M
M
Caspi
D
D
D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis; D012867:Skin / Q000473:pathology; D014382:Tuberculosis, Cutaneous / Q000150:complications* / Q000175:diagnosis; D014391:Tuberculosis, Miliary / Q000150:complications* / Q000175:diagnosis