Neglect leads to extremes: maggots and malignancy in a case of discoid lupus erythematosus.
Discoid lupus erythematosus (DLE) is a chronic form of cutaneous lupus erythematosus that runs an indolent course. The rare complications of DLE include scarring, mutilation, non-healing ulceration, cicatricial alopecia and malignancy. DLE progresses to systemic lupus erythematosus (SLE) in around 5% of localized cases and 22% of generalized cases. We report a case of DLE, presenting with a six-month history of ulcerated fungating plaques and small crusted nodules superimposed on DLE plaques over both the forearms. Two weeks prior to the presentation, maggots were also noticed on these plaques. Skin biopsies from these lesions were suggestive of squamous cell carcinoma (SCC) and keratoacanthoma. A wide surgical excision of the tumor followed by partial split-thickness skin grafting was performed with complete healing of the lesions. No recurrence has been noted 18 months from follow-up.
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
N
N
Bhari
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India binodkhaitan@hotmail.com.
B K
BK
Khaitan
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
P
P
Gupta
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
T
T
Kumar
Department of Surgery, All India Institute of Medical Sciences, New Delhi, India.
A
A
Srivastava
D000818:Animals; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007636:Keratoacanthoma / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D007814:Larva; D008179:Lupus Erythematosus, Discoid / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008875:Middle Aged; D009198:Myiasis / Q000175:diagnosis / Q000469:parasitology* / Q000628:therapy; D010349:Patient Compliance; D012867:Skin / Q000469:parasitology* / Q000473:pathology*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016038:Skin Transplantation; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
D007166:Immunosuppressive Agents
Discoid lupus erythematosus; maggots; malignancy