A middle aged female presented with swelling of face and periorbital region for 4 weeks and fever 3 weeks diagnosed and treated as cellulitis elsewhere examination revealed periorbital puffiness and indurated lesions on face with complete distortion of facial features.
Labs-hb- 10.7 gm/dl
Sr creatinine-0.8 mg/dl
Lft- sgot −87 u/L, sgpt-64 u/l
Ana if- neg
Ena profile- neg
C3, C4 n
Ct neck with contrast-diffuse enlargement of rt parotid gland
Swelling of rt masseter, buccinator sterno cleido mastoid
Gross oedema of overlying soft tissue of rt face multiple mildly enlarged ln rt sub mandibular upper and middle jugular erosion of alveolar cortex of rt post edge of maxilla.
Biopsy was done which showed -the subcut. Panniculus shows a lobular inflammatory infiltrate composed mainly of lymphocytes, hyalinising lesions wherin the adipocytes have lost nucleoli are present interspred, epidermal and dermal histomorphology- follicular plugging present,dermal vessels reveal perivascular lymphohistiocytic infiltrates, stains for afb,pas neg
Opinion-lymphocytic lobular panniculitis with follicular plugging-lupus profundus
Our case was unusual also because of parotid involvement which is a very rare presentation of lupus profundus with very few case reports.
Pateint was given steroids and mmf with little response after 6 weeks, mmf was then replaced with thalidomide leading to successful response and resolution of the swelling.
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