A 41-year-old woman presented to the Department of Dermatology with a 1-month history of painful skin lesions on her lower limbs. Physical examination showed symmetrically distributed, bright red plaques on the heels (Fig. 1A). She reported no dry eyes or dry mouth, arthralgia or RP. Laboratory tests revealed a titre of 1:160 ANA and positive anti-Ro52 and anti-Ro60 antibodies. Her anti-dsDNA antibody was negative. Severe acute respiratory syndrome coronavirus 2 nucleic acid was not detected in her nasal and pharyngeal swab specimens. A biopsy specimen of a cutaneous lesion indicated dense lymphocytic infiltrates surrounding eccrine glands and blood vessel walls, in addition to mucin deposition in collagen bundles of the dermis (Fig. 1B). Whole-exome sequencing showed that she did not carry a mutation in the TREX1 gene. A diagnosis of chilblain lupus erythematosus was made. Chilblain lupus erythematosus is an uncommon form of chronic cutaneous lupus erythematosus, typically located on the nose, ears and the dorsal surfaces of the hands or feet, associated with cold exposure [1]. The patient received a combination therapy consisting of 5 mg of oral prednisone, 200 mg of HCQ, and 4 mg of baricitinib daily. Baricitinib has been shown to be effective for improving familial chilblain lupus erythematosus and for skin and joint manifestations in patients with SLE [2]. The patient’s cutaneous erythema had abated after 2 months (Fig. 1C).
Figure 1.
Chilblain lupus on the heels. (A) Symmetrically distributed, bright red plaques on the heels. (B) Biopsy specimen of cutaneous lesion on the heels. (C) The patient’s cutaneous erythema at follow-up
Contributor Information
Jia Li, Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Yeqiang Liu, Department of Dermatopathology, Shanghai Skin Disease Hospital of Tongji University, Shanghai, China.
Data availability
The authors confirm that the data supporting the findings of this study are available within the article.
Funding
This study was supported by Clinical Research Plan of Shanghai Hospital Development Center (SHDC 12020117).
Disclosure statement: The authors have declared no conflicts of interest.
Consent: Informed consent was provided for the publication of this article.
References
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Associated Data
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Data Availability Statement
The authors confirm that the data supporting the findings of this study are available within the article.