Generalized Discoid Lupus in Systemic Lupus Erythematosus with myelopathy

Authors: Patricia Gaile E. Espinosa, MD1, Rogelio A. Balagat, MD, FPCP, FPDS, FPRA

Abstract

Introduction: The occurrence of generalized discoid lupus erythematosus (DLE) and myelopathy has not been reported to date. DLE in the context of systemic lupus erythematosus (SLE) is considered to have a more benign prognosis. Among the subsets of cutaneous lupus erythematosus (CLE), DLE is the least likely to progress to SLE. Less than 5% of DLE cases progress to SLE. We report a 19-year-old woman who presented with generalized DLE and myelopathy.

Case Summary: This is a case of a 19-year-old woman who presented with non-pruritic red circumscribed plaques on the face, ears, and arms, with some showing scarring, telangiectasia, and pigmentation. Three months later, she developed paraplegia, an inability to urinate and defecate, and a sensory loss up to the level of T10. Findings on skin biopsy, a positive antinuclear antibody (ANA), and transverse myelitis on MRI all confirm the presence of SLE.

Conclusion: DLE has 2 subtypes, localized and generalized, which affect body areas above and below the neck. Generalized DLE poses a higher risk for developing SLE (15-28%) compared to localized DLE (5-10%). Myelopathy is a rare presentation in SLE, occurring in only 1-2% of cases. Although this has not been reported before, it is possible for generalized DLE and myelopathy to co-exist. The presence of generalized DLE is a marker of a poor clinical outcome.

 

Citation

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Keywords

generalized discoid, lupus erythematosus, myelopathy

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