Lupus erythematosus panniculitis presenting with initial periorbital swelling and positive antiphospholipid antibodies: A rare association

Lupus erythematosus panniculitis (LEP), an unusual form of chronic cutaneous lupus erythematosus, is characterized by chronic inflammation and fibrosis of subcutaneous tissue. Clinically, it presents as subcutaneous nodules on common locations such as forehead, cheeks, proximal limbs and buttocks. Ulceration of the nodules may occur in certain cases. Very few case studies have reported the occurrence of early solitary periorbital involvement, highlighting the need for a high index of suspicion in such cases. We report here a case having generalized extensive LEP with initial manifestation of a solitary periorbital swelling, autoimmune hemolytic anemia, and associated antiphospholipid antibodies positivity Introduction Lupus erythematosus panniculitis (LEP) is a rare presentation of cutaneous lupus erythematosus seen only in about 2 to 7% of the patients with systemic lupus. It can also occur prior to the manifestation of systemic or discoid lupus erythematosus. The clinical manifestation involves the presence of subcutaneous nodules with adherent overlying skin, which are commonly located on the forehead, cheeks, proximal limbs and buttocks. The association of antiphospholipid antibody with LEP is very rare and only three cases have been reported till date in literature. Case report A 34-year-old female presented with complaints of subcutaneous warm tender nodules. They were first noticed over the right periorbital area with subsequent development of such lesions over arms, legs, and buttocks since two months. The nodules increased in size progressively and developed to ulceration (Fig 1 and 2). A sudden increase in the right periorbital swelling within 10 days was observed, causing inability to open the eye and painful eye movements without any diminution of vision (Fig 3). Fig1: Presence of tender erythematous subcutaneous nodule just above the right knee