Presenter: JoAnne M. LaRow. D.O.
Dermatology Program: Northeast Regional Medical Center/KCOM
Program Director: Lloyd J Cleaver, D.O.
Submitted on: Dec 15, 2005
CHIEF COMPLAINT: Skin irritation of arms, face, ears, and legs of two weeks duration.
Signs and symptoms: Initially pt noted skin irritation on her face. She saw here primary physician for this. The eruption gets itchy when pt is overheated. When asked pt states that she has had arthralgias. She complains of fatigue, but is post-partum with twins. She is not breast feeding.
Previous Treatment: Erythromycin 333mg one PO TID for ten days. Pt completed this treatment four days before presentation to our office. Also applying Triamcinolone 0.1% cream BID-TID
Other information: Pt is 15 weeks post-partum. She delivered twin girls via c-section 2/7/03. Her pregnancy was complicated by hypertension in the third trimester. After delivery she was started on Lisinopril 20 mg QD (started April 2003)
Erythematous, irregularly defined plaques on malar cheeks bilaterally, as well as on her left upper lateral arm, and right knee. Petechiae of the hard palate
ANA pattern: speckled; titer: 1:160
Antihistone Antibodies: negative
FANA: positive; 1:1280; homogeneous pattern
ENA w/o R?Nase: positive (1:256)
ENA w R’Nase: positive (1:128)
Ds DNA: positive (1:160)
Total protein urine 24hr: 2630.0 mg/dl
Total protein urine spot: 263 mg/dl
Cutaneous Direct Immunofluorescent:
IgG: diffuse granular deposits basement membrane
IgM: patchy faint granular deposits basement membrane and few globular deposits present
IgA: few cytoids (globular deposits) present
C3: diffuse granular deposits basesment membrane
CBC and ESR, and Complete metabolic profile: all within normal limits
nonspecific chronic dermatitis- superficial and deep with a perivascular pattern
2. Drug induced SLE
3. Discoid lupus
4. Granuloma Annulare
5. Drug eruption