Lupus Erythematosus Tumidus with Pseudolymphomatous Infiltrates: A Case Report

J Nippon Med Sch. 2020;87(2):100-103. doi: 10.1272/jnms.JNMS.2020_87-208.

Abstract

A 39-year-old Japanese woman presented with a pruritic infiltrated erythematous plaque on the right cheek. Histopathologic analysis of the erythema showed dermal edema, separation of collagen bundles, and nodular perivascular and periadnexal infiltration of lymphocytes in the whole dermis, without epidermal changes. Alcian blue staining intensity was elevated between the collagen bundles, indicating dermal mucinosis. The nodular infiltrates consisted of CD3+ T cell clusters and CD20+ B cell clusters (ratio, approximately 3:1) and included numerous CD123+ cells, indicative of plasmacytoid dendritic cells. Blood analysis revealed serum antinuclear antibody at a titer of 1:160 (homogeneous, speckled pattern). Lupus erythematosus tumidus with pseudolymphomatous infiltrates was diagnosed. Hydroxychloroquine treatment partially improved symptoms; however, the addition of prednisolone was required for complete resolution. Lupus erythematosus tumidus is sometimes accompanied by pseudolymphomatous infiltrates. Dermal mucinosis and the presence of numerous plasmacytoid dendritic cells are useful in differentiating lupus erythematosus tumidus from pseudolymphoma.

Keywords: lupus erythematosus tumidus; mucinosis; plasmacytoid dendritic cell; pseudolymphoma.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antigens, CD20
  • B-Lymphocytes / immunology
  • B-Lymphocytes / pathology*
  • CD3 Complex
  • Female
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Interleukin-3 Receptor alpha Subunit
  • Lupus Erythematosus, Systemic / drug therapy
  • Lupus Erythematosus, Systemic / immunology*
  • Lupus Erythematosus, Systemic / pathology*
  • Pseudolymphoma / drug therapy
  • Pseudolymphoma / immunology*
  • Pseudolymphoma / pathology*
  • T-Lymphocytes / immunology
  • T-Lymphocytes / pathology*

Substances

  • Antigens, CD20
  • CD3 Complex
  • Interleukin-3 Receptor alpha Subunit
  • Hydroxychloroquine