Vasculitis-like lesions as the initial manifestation of systemic lupus erythematosus: Case report

Background. Systemic lupus erythematosus (SLE) is a complex autoimmune disease with diverse multiorgan involvement, including cutaneous, cardiovascular, renal, and neuropsychiatric manifestations. Early diagnosis can be challenging, especially when initial symptoms mimic other conditions. Case presentation. We report a case of a 56-year-old female who presented with vasculitis-like skin lesions and oral ulcers – specifically on the right anterior region of the tongue and buccal mucosa, which were in remission at examination. She also exhibited disseminated monomorphic dermatosis on the anterolateral aspects of the legs, with small islands of unaffected skin. The lesions consisted of confluent purpuric macules that did not blanch under pressure, had an acute onset, and were accompanied by pruritus. Initially, a vasculitic process was suspected; however, this was ruled out due to negative p-ANCA and c-ANCA antibodies. Infectious causes were excluded, and serological tests revealed positive antinuclear antibodies (ANA) and lupus anticoagulant. A skin biopsy confirmed the diagnosis of SLE, fulfilling the 2019 EULAR/ACR classification criteria. Treatment with mycophenolic acid and topical corticosteroids was initiated. Conclusion. This case highlights an atypical initial presentation of SLE with vasculitis-like lesions, underscoring the importance of considering autoimmune etiologies in patients with similar clinical features to enable early and appropriate treatment.