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Fırat Tıp Dergisi
2011, Cilt 16, Sayı 1, Sayfa(lar) 036-037
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Lupus Panniculitis as a Complication of Herpes Zoster
Volkan GENÇ1, Aysun GENÇ2, Ahmet Serdar KARACA1, Gökhan ÇİPE1, Elif NERGİZ1, Salim İlksen BAŞÇEKEN1, Murat TURGAY3
1Ankara Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, ANKARA, Türkiye
2Ankara Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, ANKARA, Türkiye
3Ankara Üniversitesi Tıp Fakültesi, Romatoloji Bilim Dalı, ANKARA, Türkiye
Keywords: Lupus, panniculitis, herpes zoster, Lupus, pannikülit, herpes zoster
Summary
A 55-year-old woman with a 7 year history of systemic lupus erythematosus was consulted to our surgical clinic from immunology department due to exhausting left inguinal pain. She was diagnosed with herpes zoster but her complaints increased despite of the treatment of herpes zoster. Magnetic resonance imaging showed the fluid collection, cutaneous and subcutaneous oedema association with panniculitis only in the herpes zoster area. We think that panniculitis in our patient is triggered by herpes zoster infection because of same location of these two diseases. It is first reported entity which shown correlation between viral infections and lupus panniculitis.
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  • Summary
  • Introduction
  • Case Presentation
  • Disscussion
  • References
  • Introduction
    Systemic lupus erythematosus (SLE) is a multisystem, autoimmune, connective-tissue disorder with a wide range of clinical features1. Lupus panniculitis (LP) or lupus erythematosus profundus is a rare and cutaneous clinical variant of SLE2. We reported a case with LP as a complication of herpes zoster infection.
  • Top
  • Summary
  • Introduction
  • Case Presentation
  • Disscussion
  • References
  • Case Presentation
    A 55-year-old woman with a 7 year history of SLE was consulted to our surgical clinic from immunology department due to exhausting left inguinal pain. She had been taking flantadin 3 mg once a day and hidroxychloroquine 200 mg twice a day for last two years.

    Firstly the patient had been consulted to Dermatology clinic due to painful, progressive vesicular lesions on her left inguinal area. She was diagnosed with herpes zoster and given famsiklovir. We also detected oedema, vesicular lesions, and painful joint motion of hip on physical examination (Figure 1). Her peripheral blood leukocyte count and erythrocyte sedimentation rate were 9100/mm3 and 50 mm/h, respectively. Serum chemistry values were normal. Magnetic resonance imaging (MRI) was performed due to painful joint motion of hip. MRI showed the fluid collection, cutaneous and subcutaneous oedema association with panniculitis only in the herpes zoster area (Figure 2).


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    Figure 1: Vesicular lesions and oedema were shown.


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    Figure 2: MRI appearance of the fluid collection and cutaneous-subcutaneous oedema association with panniculitis.

    Famsiklovir and symptomatic treatment consists in topically corticosteroid and oral nonsteroidal anti-inflammatory drugs were used. On 15 days her complaints highly decreased and control ultrasonography was completely normal.

  • Top
  • Summary
  • Introduction
  • Case Presentation
  • Disscussion
  • References
  • Discussion
    Systemic lupus erythematosus (SLE) is a multisystem, autoimmune, connective-tissue disorder with a wide range of clinical features. This disease mainly involves the skin, joints, kidneys, blood cells, and nervous system. Treatments range from antimalarial agents to corticosteroids and immunosuppressive agents1. The use of this agents, and biological therapies increases the risk of infections, mainly bacterial, in patients with SLE. Furthermore Ramos-Casals and colleagues have shown a predisposition of viral infections in patient with SLE. The detected of most common viral infections are parvovirus B19, cytomegalovirus herpes simplex virus, Epstein barr virus and varicella zoster virus. This predisposition increases in case of the treatment of immunosuppression in these patients3. LP or lupus erythematosus profundus is a rare and cutaneous clinical variant of SLE. It was first described by Kaposi in 18834. The frequency of occurrence of LP in SLE has been reported to be 2%2. It causes inflammatory reaction in the deep subcutaneous adipose tissue. The most common sites of involvement LP are the upper limbs, thighs and buttocks5,6. The etiology is uncertain. Histologically, lymphocytic lobular panniculitis and a characteristic hyaline sclerosis of the adipose tissue are defined. Treatment is primarily medical because of surgical intervention aggravates the clinic of disease7.

    It is relatively difficult to make the diagnosis of LP in our patient due to herpes zoster infection in the same area. Initially we focused the treatment of herpes zoster and we didn't think panniculitis. When her complaints increased despite of the treatment of herpes zoster, correct diagnosis was made owing to magnetic resonance imaging. We think that panniculitis in our patient is triggered by herpes zoster infection because of same location of these two diseases. It is first reported entity which shown correlation between viral infections and LP.

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  • Summary
  • Introduction
  • Case Presentation
  • Discussion
  • References
  • References

    1) D'Cruz D, Khamashta M, Hughes G. Systemic lupus erythematosus. Lancet 2007; 17: 587-596.

    2) Díaz-Jouanen E, DeHoratius RJ, Alarcón Segovia D, Messner RP. Systemic lupus erythematosus presenting as panniculitis (lupus profundus). Ann Intern Med 1975; 82: 376-379.

    3) Ramos-Casals M, Cuadrado MJ, Alba P, et al. Acute viral infections in patients with systemic lupus erythematosus: description of 23 cases and review of the literature. Medicine (Baltimore). 2008; 87: 311-318.

    4) Kaposi M. Pathologie und therapie der Hautkrankheiten, 2nd ed. Vienna, Urban&Schwarzenberg 1883: 642.

    5) Martens PB, Moder KG, Ahmed I. Lupus panniculitis: clinical perspectives from a case series. J Rheumatol 1999; 26: 68-72.

    6) Aydogan K, Adım SB, Tokgoz N, Tunalı S. Lupus Eritematozus Panniküliti: Olgu Sunumu ve Literatürün Gözden Geçirilmesi. Turkiye Klinikleri Dermatol 2004; 14: 93-99.

    7) Arai S, Katsuoka K. Clinical entity of Lupus erythematosus panniculitis/lupus erythematosus profundus. Autoimmunity Rev 2009; 8: 449-452.

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  • Summary
  • Introduction
  • Case Presentation
  • Discussion
  • References
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