Lupus Panniculitis - A Case Report With Long-Term Follow-Up

Lupus erythematosus panniculitis (LEP), also known as lupus erythematosus profundus, is a rare subtype of chronic cutaneous lupus erythematosus (CCLE), characterized by inflammation of the subcutaneous adipose tissue. It is estimated to affect 1-3% of patients diagnosed with cutaneous lupus. It can present as a distinct clinical entity or in association with discoid lupus erythematosus (DLE) or systemic lupus erythematosus (SLE). We report a case of lupus panniculitis with long-term follow-up in a 54-year-old woman, initially presenting with unilateral periorbital erythema and edema. The patient’s medical history revealed intermittent episodes of unilateral periorbital edema on the affected side over the previous three years along with the development of an erythematous, indurated lesion on the right cheek, which resolved with an atrophic, depressed plaque. During this period, the patient had been treated with oral antibiotics, corticosteroids, and antiviral therapy due to suspected clinical diagnoses of contact dermatitis, recurrent herpes simplex, and periorbital cellulitis. Considering the patient’s history, clinical presentation, histological evidence of lymphocytic lobular panniculitis, and immunological findings, a diagnosis of lupus panniculitis was established. The patient demonstrated an excellent response to treatment with hydroxychloroquine and prednisolone, achieving complete resolution of her dermatological symptoms. However, after a three-year period without medical supervision and discontinuation of therapy, she presented with new lesions on the facial region, including one on the nose suspected to be DLE and multiple atrophic, depressed plaques on the upper arms.