Diagnostic Challenges of Hypertrophic Lupus Erythematosus
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Keywords
Hypertrophic lupus erythematosus, CD123, Immunostain, Intralesional Kenalog
Abstract
Hypertrophic lupus erythematosus (HLE) often occurs in the absence of systemic symptoms and can be misdiagnosed as squamous cell carcinoma (SCC) as both appear clinically as erythematous scaling plaques in sun exposed areas and histologically show significant epithelial hyperplasia. No single criterion confidently differentiates HLE from SCC histologically, postulating the need for CD123 immunostaining in evaluating locally recurring, supposed SCCs. We present a woman who presented for evaluation of multiple supposed left lower leg well-differentiated SCCs (wdSCC), that did not resolve following Mohs Micrographic Surgery and other techniques aimed at cancer removal. The lesions improved following intralesional Kenalog injection and showed positive CD123 immonostains, which both led to the diagnosis of HLE.
References
2. Ko CJ, Srivastava B, Braverman I, Antaya RJ, McNiff JM. Hypertrophic lupus erythematosus: the diagnostic utility of CD123 staining. J Cutan Pathol. 2011 Nov;38(11):889-92. doi: 10.1111/j.1600-0560.2011.01779.x. PMID: 21955314; PMCID: PMC4103013.
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Dr. Callie Hill, University of Alabama at Birmingham, Department of Dermatology
University of Alabama at Birmingham, Department of Dermatology, 2nd year Dermatology resident
Victoria Jiminez, University of Alabama at Birmingham School of Medicine
HEERSINK University of Alabama at Birmingham School of Medicine, First year medical student
Dr. Carlton Blake Phillips, University of Alabama at Birmingham, Department of Dermatology
University of Alabama at Birmingham, Department of Dermatology, Mohs Micrographic Surgery Attending