Late-onset systemic lupus erythematosus with leukocytoclastic vasculitis, hypertension, myocarditis, and lupus nephritis

A case report.

Abstract

Introduction: Systemic lupus erythematosus is a systemic autoimmune disease that can affect multiple organs, including vascular structures, although this involvement is uncommon. Leukocytoclastic vasculitis is a rare form of small-vessel vasculitis characterized by inflammation of dermal venules and manifests clinically as palpable purpura. Its association with myocarditis, hypertension, and lupus nephritis is uncommon and presents a diagnostic and therapeutic challenge.

Case Report: We present the case of a 53-year-old female patient who consulted for purpuric lesions on her lower extremities, pretibial edema, and joint symptoms. Her condition was complicated by severe hypertension, myocarditis, and lupus nephritis. Skin and kidney biopsies confirmed the diagnoses of leukocytoclastic vasculitis and lupus nephritis, respectively.

Outcome: The patient was treated with intravenous methylprednisolone, followed by prednisolone, with significant improvement in clinical manifestations and laboratory parameters.

Conclusion: This case highlights the diverse presentations of SLE, particularly its association with leukocytoclastic vasculitis, a rare but relevant manifestation. Early management with immunosuppressants led to a favorable clinical outcome. This report underscores the importance of suspecting SLE in patients with atypical vasculitis and of adopting a multidisciplinary approach to achieve timely diagnosis and treatment.