title: Nonbullous neutrophilic lupus erythematosus: a newly recognized variant of cutaneous lupus erythematosus.
abstract: BACKGROUND
  Neutrophils in the setting of systemic lupus erythematosus (SLE) are commonly associated with bullous disease. Rare cases of nonbullous neutrophilic lesions have been reported in patients with SLE.
  
  
  OBJECTIVE
  This study used clinical and histologic findings of 4 patients to further define the newly emerging entity of nonbullous neutrophilic lupus erythematosus (LE).
  
  
  METHODS
  We reviewed the clinical and pathological findings of 4 patients with known SLE who developed urticarial papules, plaques, subcutaneous nodules, or a combination of these.
  
  
  RESULTS
  All patients were women with established SLE. Histopathological findings in all patients included an interstitial and perivascular neutrophilic infiltrate with leukocytoclasia, and variable vacuolar alteration along the dermoepidermal junction. Direct immunofluorescence study results in two patients were positive for C3, IgG, and IgM along the basement membrane zone. One patient also presented with neutrophil-rich lupus panniculitis. All clinical lesions resolved with immunomodulating/immunosuppressive agents.
  
  
  CONCLUSIONS
  This study was limited by the small number of cases.
  
  
  CONCLUSIONS
  Nonbullous neutrophilic LE is an important entity to consider in the differential diagnosis of neutrophil-mediated eruptions. In addition, the histologic finding of neutrophils in the setting of lupus should alert one to the possibility of systemic disease.
authors: Department of Pathology, Virginia Commonwealth University, Richmond, Virginia 23298, USA. nbrinster@mcvh-vcu.edu
authors: Nooshin K
authors: NK
authors: Brinster
authors: Julia
authors: J
authors: Nunley
authors: Robert
authors: R
authors: Pariser
authors: Brian
authors: B
authors: Horvath
mesh_terms: D000293:Adolescent; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008178:Lupus Erythematosus, Cutaneous / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology; D055815:Young Adult