Lupus erythematosus panniculitis: A case report Besma Ben Dhaou a,⇑ , Asma kefi a , Zohra Aydi a , Imen Rachdi a , Houda Hammami b , Fatma Daoud a , Ehsen Ben Brahim c , Sami Fenniche b , Achraf Debbiche c , Fatma Boussema a a Department of Internal Medicine, Habib Thameur Hospital, Tunis, Tunisia b Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia c Department of Anatomopathology, Habib Thameur Hospital, Tunis, Tunisia Received 11 May 2016; accepted 14 October 2016 Available online 16 November 2016 Abstract Lupus erythematosus panniculitis (LEP), an uncommon variant in the clinicopathological spectrum of lupus erythematosus (LE), is rare. There are only a few reported series of patients with this condition; none in individuals of North African ancestry. LEP is charac- terized by inflammation of the deep dermis and subcutaneous tissue. It usually consists of nodules and hardened subcutaneous plaques on the forehead, cheeks, proximal extremities, and buttocks. Leg involvement is rare and can lead to misdiagnosis. A case of LEP, with unu- sual involvement of legs, is reported in a 40-year-old woman who had the diagnosis of systemic lupus erythematosus (SLE) four years ago. Production and hosting by Elsevier B.V. on behalf of King Saud University. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/). Keywords: Lupus erythematosus panniculitis; Systemic lupus erythematosus; Leg; Skin disease; Treatment 1. Introduction Systemic lupus erythematosus (SLE) is a remarkable and challenging disorder. The clinical course, extremely variable, ranges from life-threatening to mild diseases that never require hospitalization. Its diversity of clinical fea- tures is matched by the complexity of the factors (genetic, hormonal, and environmental) that cause it, and the array of autoantibodies with which it is associated (Lisnevskaia et al., 2014). Cutaneous manifestations of SLE are present in 85% of patients during the course of the disease (Rothfield, 1989). A variety of skin features can be proved in lupus patients, including lupus erythematosus panniculi- tis (LEP) (Kuhn et al., 2007). LEP is a rare variant of chronic cutaneous lupus erythematosus characterized by inflammatory lesions in the lower dermis and subcutaneous tissue. Patients with LEP present most commonly without any or only mild signs of systemic manifestations and it can only be found in 2% of patients with SLE (Mascaro et al., 1997). LEP is usually characterized by a relapsing and remitting clinical course. The lesions of LEP occur primar- ily in areas prone to trauma, namely, on the cheeks, shoul- ders, thighs, and breast. LEP involving legs is unusual (Fraga and Garcı ´a-Dı ´ez, 2008). We herein describe a case of a 40-year-old woman with LEP in the leg associated with overt relapsing SLE symptoms. 2. Case report A 40- year-old Tunisian woman was admitted in our department, in August 2014, with tender deep-seated nod- ules on the 2 legs of one month evolution. She also had a malar rash with oral ulcers. http://dx.doi.org/10.1016/j.jdds.2016.10.003 2352-2410/Production and hosting by Elsevier B.V. on behalf of King Saud University. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). ⇑ Corresponding author. E-mail addresses: besma.bendhaou@yahoo.fr, bendhaoub66@gmail. com (B. Ben Dhaou). Peer review under responsibility of King Saud University. Production and hosting by Elsevier Available online at www.sciencedirect.com www.jdds.org ScienceDirect Journal of Dermatology & Dermatologic Surgery 21 (2017) 110–112