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case_images: Skin lesions before and after upadacitinib treatment. (A-C) show the patient's skin lesions before upadacitinib treatment. (D-F) show the patient's skin lesions after 4 weeks of upadacitinib 15mg QD treatment. (G-I) show the patient's skin lesions after 10 weeks of upadacitinib 15mg QD treatment. (J-L) show the patient's skin lesions after 4 weeks of upadacitinib 15mg QOD treatment. (M-O) show the patient's skin lesions after restarting upadacitinib 15mg QD treatment for 6 weeks. (P-R) show the patient's skin lesions after upadacitinib 15mg QD in combination with topical benzoyl peroxide treatment for 8 weeks.
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case_images: Physical examination showed erythema and swelling on both cheeks, particularly on the right side, with a relatively clear boundary (Figure 1A-C). At the 4-week follow-up visit, the patient's skin lesions had significantly improved (Figure 1D-F). At the 10-week follow-up visit, the skin lesions had further improved (Figure 1G-I), and the HBV DNA quantitation was 1.49 x 105 IU/mL, with normal complete blood counts, liver and kidney function, high-sensitivity C-reactive protein, blood lipids, and creatine kinase level. The reduction of upadacitinib for 4 weeks resulted in a relapse of the lesions (Figure 1J-L). After 20 weeks of upadacitinib treatment, the patient's facial erythema improved (Figure 1M-O).
case_images: Pathological pictures of the skin lesion. (A and B) show the pathological pictures of the facial lesion of the patient at 4x magnification using hematoxylin and eosin (HE) staining. (C and D) show the pathological pictures of the facial lesion of the patient at 10x magnification using HE staining. The HE staining pictures revealed hair follicle plugging, vacuolar degeneration of basal cells with Civatte bodies, indistinct interface, lymphocytic infiltration around superficial and deep dermal vessels and cutaneous appendages, edema in the superficial dermis with widened collagen bundle gap. The arrow in (D) indicates a Civatte body. Panels (E) and (F) are the direct immunofluorescence (DIF) pictures of the facial lesion of the patient at 10x magnification using IgG and C3 antibodies respectively. DIF pictures revealed a characteristic lupus band at the basement membrane zone (BMZ).
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case_images: Histopathological pictures of the skin lesion revealed hair follicle plugging, vacuolar degeneration of basal cells with Civatte bodies, indistinct interface, lymphocytic infiltration around superficial and deep dermal vessels and cutaneous appendages, edema in the superficial dermis with widened collagen bundle gap (Figure 2A-D). Direct immunofluorescence (DIF) test using IgG and C3 antibodies revealed a characteristic lupus band at the basement membrane zone (BMZ) (Figure 2E and F).