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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 |
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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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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. |
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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).
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. |
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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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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.
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