Description Digital ulcers and gangrene are common cutaneous manifestations of connective tissue diseases. They are frequently seen in systemic sclerosis, but are relatively rare in systemic lupus erythematosus (SLE). There are only 0.2% SLE patients who initially present as digital gangrene.
We report a case of a 35-year-old woman presented with pain and necrosis of finger tips. She has been diagnosed with SLE for 2 years and was taking immunosuppressant regularly but quit the medication 6 month prior to admission and experience recurring Raynaud phenomenon. There is no history of infections, drug addiction, trauma, diabetes, miscarriage, or vascular disease. A diagnosis of SLE with digital gangrene has been established based on clinical appearance (figure 1). The patient has a High Disease activity with MEX SLEDAI score 14. Laboratory findings showed RNP/Sm +, RIB +, thrombocytopenic, anemia hemolytic, with high ESR 50/81 and no coagulopathy. On radiological examination, no signs of vascular disease nor thrombus were found. The patient was treated with steroid, methotrexate and sildenafil and showed clinical and laboratory improvement.
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