Cutaneous Lupus Erythematosus Presenting as Persistent Periorbital Edema: A Report of Two Cases
DOI:
https://doi.org/10.12970/2310-9874.2020.08.04Keywords:
Autoimmune diseases, lupus erythematosus tumidus, cutaneous lupus, periorbital edema, lupus tumidus treatment.Abstract
Background: Cutaneous lupus erythematosus (CLE) is a chronic, autoimmune, inflammatory disease characterized by a multi-factorial etiology and a spectrum of cutaneous manifestations with variable evolution. Several CLE variants exist with varying clinical and histopathologic features, depending on the extent of epidermal and/or dermal involvement. Persistent, periorbital edema as the sole clinical manifestation of CLE is rarely reported. We report two cases of lupus tumidus presenting with periorbital edema.
Case Presentations: This is the case of two, unrelated, middle-aged patients with a chronic history of periorbital edema whose review of systems were negative for systemic involvement. Physical examination in both cases revealed periorbital, non-tender, erythematous plaques associated with significant non-pitting edema. No epidermal changes were noted. Rheumatologic and thyroid studies were unremarkable. Histopathology in both patients showed a superficial and deep perivascular lymphocytic infiltrate as well as mucin deposition. After a clinical and histopathologic correlation, a diagnosis of CLE in the spectrum of lupus tumidus was made. In both cases, clinical improvement over the course of several weeks was observed with a taper of oral prednisone 40 mg daily and hydrochloroquinine 200 mg twice daily.
Discussion: Several CLE variants exist in a clinical spectrum where cutaneous and histopathologic findings range from predominant epidermal involvement to mostly dermal involvement. Although uncommon, periorbital edema may be the sole manifestation of CLE. It is important to suspect CLE in cases of persistent, periocular edema in order to avoid delays in diagnosis and treatment.
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