title: [Systemic lupus erythematosus : Unusual cutaneous manifestations].
abstract: BACKGROUND
  Various different mucocutaneous symptoms may affect up to 80 % of systemic lupus erythematosus (SLE) patients.
  
  
  OBJECTIVE
  To investigate, various unspecific, but otherwise typical clinical symptoms of skin and mucous membranes that arise in SLE patients other than those defined as SLE criteria such as butterfly rash, chronic cutaneous lupus erythematosus, oral ulcers, and increased photosensitivity.
  
  
  METHODS
  Extensive search of peer-reviewed scientific articles was performed, medical histories of several SLE patients seen in our department were analyzed, and the rare disease courses in three SLE patients are presented.
  
  
  RESULTS
  Here we present a variety of unspecific but typical mucocutaneous manifestations in SLE patients: periungual erythema, periungual telangiectasia and periungual splinter hemorrhage, papules on the dorsum of the hands, scaling erythema, sometimes associated with necrosis, especially of the ears, along with complement deficiency, and the bizarre necroses of antiphospholipid syndrome. Furthermore, we show the typical clinico-histological features of neutrophilic urticarial dermatosis, as well as those of bullous SLE and finally a severe course of bacterial sepsis with Neisseria flavescens/macacae.
  
  
  CONCLUSIONS
  Here we show several unspecific but rather typical mucocutaneous symptoms in lupus patients that are indicative of SLE and thus may lead to an early diagnosis. Also, life-threatening bacterial sepsis may occur with microorganisms that are commonly considered "apathogenic", such as Neisseria flavescens/macacae, which exclusively affect immunosuppressed patients.
authors.affiliation: Abteilung Dermatologie und Venerologie, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Wien, Österreich. theresa.stockinger@wienkav.at.
authors.forename: T
authors.initials: T
authors.lastname: Stockinger
authors.affiliation: Abteilung Dermatologie und Venerologie, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Wien, Österreich.
authors.forename: L
authors.initials: L
authors.lastname: Richter
authors.affiliation: Abteilung Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich.
authors.forename: M
authors.initials: M
authors.lastname: Kanzler
authors.affiliation: Abteilung Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich.
authors.forename: M
authors.initials: M
authors.lastname: Melichart-Kotik
authors.affiliation: Abteilung Dermatologie, Zentrum für blasenbildende Erkrankungen, Universitätsklinik Groningen, Groningen, Niederlande.
authors.forename: H
authors.initials: H
authors.lastname: Pas
authors.affiliation: Klinische Abteilung für Nephrologie und Dialyse, Universitätsklinik für Innere Medizin III, Allgemeines Krankenhaus Wien, Wien, Österreich.
authors.forename: K
authors.initials: K
authors.lastname: Derfler
authors.affiliation: Abteilung Dermatologie, Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck, Lübeck, Deutschland.
authors.forename: E
authors.initials: E
authors.lastname: Schmidt
authors.affiliation: Abteilung Dermatologie und Venerologie, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Wien, Österreich.
authors.forename: K
authors.initials: K
authors.lastname: Rappersberger
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D035583:Rare Diseases / Q000175:diagnosis / Q000209:etiology; D012871:Skin Diseases / Q000175:diagnosis* / Q000209:etiology*; D063189:Symptom Assessment / Q000379:methods*
keywords: Antibodies; Bullous SLE; Immunosuppression; Neisseria flavescens infection; Neutrophilic urticarial dermatosis