Bilateral Earlobe Purpura as an Unusual Initial Manifestation of Systemic Lupus Erythematosus: A Case Report

Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease characterized by autoantibody production, particularly antinuclear antibodies (ANAs).The broad clinical spectrum and absence of pathognomonic features can make diagnosis challenging, particularly when alternative autoimmune, infectious, and hematological conditions must be considered.We report a case of a 31-yearold woman who presented to the emergency department with a two-week history of bilateral earlobe purpura.Initial investigations demonstrated severe thrombocytopenia and normocytic anemia, and subsequent imaging revealed widespread lymphadenopathy.Early multidisciplinary assessment by acute medicine, hematology, and rheumatology, together with exclusion of hematological malignancy and positive autoimmune serology, supported a diagnosis of SLE.Despite initial treatment with intravenous immunoglobulin (IVIg) and corticosteroids, the bicytopenia persisted.Mycophenolate mofetil was commenced; however, worsening cytopenias and concern for secondary hemophagocytic lymphohistiocytosis led to the initiation of rituximab infusions.Her platelet count subsequently improved, and she was discharged with rheumatology and hematology follow-up.This case highlights an unusual cutaneous presentation of newly diagnosed SLE and the diagnostic challenges associated with severe hematological involvement at initial presentation.It also demonstrates the importance of multidisciplinary assessment and timely escalation of immunosuppressive therapy in severe disease.