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Lupus
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Atypical cutaneous findings in a patient with systemic lupus erythematosus

O Elkayam

Department of Rheumatology, Tel Aviv ‘Sourasky’ Medical Center, Tel Aviv, Israel, oribe14{at}netvision.net.il

A Gat

Department of Pathology, Tel Aviv ‘Sourasky’ Medical Center, Tel Aviv, Israel

M Lidgi

Department of Tuberculosis, Shmuel Harofeh Medical Center, Tel Aviv, Israel

R Segal

Department of Tuberculosis, Shmuel Harofeh Medical Center, Tel Aviv, Israel

M Yaron

Department of Rheumatology, Tel Aviv ‘Sourasky’ Medical Center, Tel Aviv, Israel

D Caspi

Department of Rheumatology, Tel Aviv ‘Sourasky’ Medical Center, Tel Aviv, Israel

A previouslydiagnosed systemic lupus erythematosuspatient presented with arthralgia, skin rash and muscular weakness. When treated with high-dose corticosteroids and methotrexate she improved, except for a persistent lesion in the hand which evolved into a profound ulcer, along with tender subcutaneous nodules in the calf. A skin biopsy disclosed necrotizing vasculitis with giant cell granuloma revealing acid fast positive bacteria on ziels nilsen staining. A chest X-ray disclosed miliary tuberculosis (TB). The patient was diagnosed as miliary TB with prominent cutaneous involvement and treated with four anti-tuberculous drugs with slow resolution of her systemic, pulmonary and skin signs.

Key Words: cutaneous • miliary • systemic lupus erythematosus • tuberculosis

Lupus, Vol. 12, No. 5, 413-417 (2003)
DOI: 10.1191/0961203303lu376cr
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