LUPUS PANNICULITIS IN SYSTEMIC LUPUS ERYTHEMATOSUS

Background: Panniculitis represents an inflammatory condition affecting the subcutaneous adipose tissue and may be associated with infections, metabolic disorders, malignancies, or autoimmune diseases. Lupus panniculitis, also known as lupus profundus, is an uncommon manifestation of systemic lupus erythematosus (SLE) and may occasionally represent an early or isolated manifestation of the disease.

Objective: To describe a case of lupus panniculitis that preceded the diagnosis of systemic lupus erythematosus and to highlight the diagnostic difficulties encountered in the absence of systemic manifestations.

Methods: Clinical data, laboratory investigations, and histopathological findings were retrospectively analyzed in a patient presenting with persistent panniculitic lesions.

Results: A 63-year-old female developed multiple painless erythematous nodules located on the trunk, buttocks, and extremities. Over a period of 5–6 months, the lesions progressively enlarged and some evolved into ulcerations. Initial laboratory investigations, including autoimmune markers, were within normal limits. Due to the persistence of lesions for approximately one year, a skin biopsy was performed, revealing histopathological features compatible with lupus panniculitis. Immunological abnormalities appeared approximately twelve months after the onset of skin manifestations, allowing the diagnosis of systemic lupus erythematosus to be established. The delay in diagnosis contributed to the development of extensive ulceration and atrophic scarring.

Conclusion: Lupus panniculitis may precede systemic lupus erythematosus and can represent a significant diagnostic challenge when systemic manifestations are absent. Early histopathological evaluation of persistent panniculitic lesions may facilitate timely diagnosis and prevent irreversible tissue damage.