Isolated cutaneous panniculitis in Sjögren’s disease exacerbated by COVID-19 illness

A 50-year-old female presented with a 6-month history of a tender left thigh lesion with no preceding trauma.This is on a background of primary Sjögren's disease (SjD) manifesting with fatigue, sicca symptoms, anti-Ro52, anti-Ro60 and a positive minor salivary gland biopsy, meeting 2016 ACR/ EULAR classification criteria.A raised and pigmented lesion was noted (Fig. 1A).There were no other cutaneous lesions and features of active SjD including lymphadenopathy or synovitis.Investigations included normal inflammatory markers and an undetectable anti-double-stranded DNA antibody (Farr assay).Infectious disease investigations were unremarkable.An incisional biopsy showed lobular, non-dysplastic lymphocytic infiltrates and no evidence of vasculitis or granulomas (Fig. 1B).There were no features of malignancy or subcutaneous panniculitis-like T cell lymphoma (SPTCL) such as atypical T cell adipocyte rimming and bean bag cells, and