Lupus pernio

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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169 Lupus pernio

Instruction

Look at this patient’s face.

Salient features

History

• Shortness of breath, cough, chest discomfort

• Fatigue, weight loss, malaise, anorexia

• History of therapy with interferon-alfa (particularly in patients with hepatitis C; interferon-alfa increases interferon-γ and interleukin-2, thus promoting granuloma formation).

Examination

• Reddish blue or violaceous plaques on the nose (Fig. 169.1), cheeks, ears and fingers, with telangiectasia over and around the plaques (Fig. 169.2).

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Fig. 169.1 Lupus pernio plaques on the nose.

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Fig. 169.2 Telangiectasia over and around the plaques.

Proceed as follows:

• Tell the examiner that you would like to do radiography for hilar adenopathy and examine the eyes for ocular manifestations

Diagnosis

This patient has violaceous plaques on his face (lesion) caused by sarcoidosis (aetiology), which is cosmetically disfiguring (functional status).

Advanced-level questions

What is the differential diagnosis of such a lesion?

• Rhinophyma (p. 633)

• Lupus vulgaris

• Leprosy.

What are the cutaneous manifestations of sarcoid?

• Erythema nodosum (p. 665)

• Micropapular sarcoid

• Scar infiltration

• Sarcoid plaques of limbs, shoulders, buttocks and thighs.

How may sarcoid present?

• Acute sarcoidosis usually presents in the third decade, characterized by erythema nodosum, parotid enlargement and hilar lymphadenopathy.

• Chronic sarcoidosis usually presents in the fifth decade with an insidious onset characterized by fatigue, dyspnoea, arthralgia and lupus pernio. Bone cysts are another feature.

How would you investigate such a patient?

• FBC and ESR: leukopenia, eosinophilia and raised ESR

• Chest radiography. Three stages of sarcoidosis are defined depending on radiographic findings, although these stages do not indicate chronology of disease:

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