• Nauman Ismat Butt Azra Naheed Medical College, Superior University Lahore Pakistan
  • Fahmina Ashfaq Azra Naheed Medical College, Superior University Lahore Pakistan
  • Khalid Mehmood Azra Naheed Medical College, Superior University Lahore Pakistan
  • Sabeen Aftab Azra Naheed Medical College, Superior University Lahore Pakistan
  • Ali Anwar Azra Naheed Medical College, Superior University Lahore Pakistan
  • Minhal Saeed Azra Naheed Medical College, Superior University Lahore Pakistan



Systemic Lupus Erythematosus, ANA, Cutaneous Vasculitis, Pulmonary Vasculitis


We present the case of a 30-year-old woman who presented with 8-month history of intermittent fever, joint pains with morning stiffness, recurrent oral ulcers, photosensitivity, weight loss and hair fall. For the last 2 month she had developed dry cough with progressive shortening of breath. On examination, a cachexic lady with malar hyperpigmentation, alopecia, pallor, nail dystrophy and erythema over hands and feet were noted. There were multiple punched-out skin ulcers of variable size over legs, arms and abdomen usually round in shape with well-defined even wound margins and scant serous discharge. Musculoskeletal examination revealed synovitis of both elbows and few metacarpophalangeal and proximal interphalangeal joints. Chest X-ray and HRCT showed bilateral ground-glass opacification. Anti-Nuclear Antibody (ANA) was positive, 1:320, homogenous nuclear pattern. Anti-Ro antibody was high positive and serum complement (C3, C4) levels were reduced. She was diagnosed as Lupus Vasculitis and started on steroids, mycophenolate mofetil and hydroxycholoroquine.


Leone P, Prete M, Malerba E, Bray A, Susca N, Ingravallo G, et al. Lupus Vasculitis: An Overview. Biomedicines 2021;9(11):1626.

Ramos-Casals M, Nardi N, Lagrutta M, Brito-Zeron P, Bove A, Delgado G, et al. Vasculitis in systemic lupus erythematosus: Prevalence and clinical characteristics in 670 patients. Medicine (Baltimore) 2006;85(2):95–104.

Fessler BJ, Hoffman GS. Vasculitis. In: Lahita RG, editor. Systemic Lupus Erythematosus. 5th ed. Academic Press; Cambridge, MA, USA: 2011; p.833–45.

Drenkard C, Villa AR, Reyes E, Abello M, Alarcón-Segovia D. Vasculitis in systemic lupus erythematosus. Lupus 1997;6(3):235–42.

Kallas R, Goldman D, Petri MA. Cutaneous vasculitis in SLE. Lupus Sci Med 2020;7(1):e000411.

Sharma A, Dhooria A, Aggarwal A, Rathi M, Chandran V. Connective Tissue Disorder-Associated Vasculitis. Curr Rheumatol Rep 2016;18(6):31.

Uthman I. Pharmacological therapy of vasculitis: an update. Curr Opin Pharmacol 2004;4(2):177–82.

Micheletti RG, Pagnoux C. Management of cutaneous vasculitis. Presse Med 2020;49(3):104033.

Wang D, Chen H, Wang S, Zou Y, Li J, Pan J, et al. Thalidomide treatment in cutaneous lesions of systemic lupus erythematosus: a multicenter study in China. Clin Rheumatol 2016;35(6):1521–7.

Walling HW, Sontheimer RD. Cutaneous lupus erythematosus: issues in diagnosis and treatment. Am J Clin Dermatol 2009;10(6):365–81.

Callen JP, af Ekenstam E. Cutaneous leukocytoclastic vasculitis: clinical experience in 44 patients. South Med J 1987;80(7):848–51.

Calle-Botero E, Abril A. Lupus Vasculitis. Curr Rheumatol Rep 2020;22(10):71.

Yang L, Zeng YP. Cutaneous Vasculitis in Systemic Lupus Erythematosus. JAMA Dermatol 2021;157(8):991.

Stumpf MAM, Quintino CR, Rodrigues MAVM, de Campos FPF, Maruta CW. Cutaneous vasculitis in lupus treated with IV immunoglobulin. Clin Rheumatol 2021;40(7):3023–4.

Wang CR, Liu MF, Weng CT, Lin WC, Li WT, Tsai HW. Systemic lupus erythematosus-associated diffuse alveolar haemorrhage: a single-centre experience in Han Chinese patients. Scand J Rheumatol 2018;47(5):392–9.

Al-Adhoubi NK, Bystrom J. Systemic lupus erythematosus and diffuse alveolar hemorrhage, etiology and novel treatment strategies. Lupus 2020;29(4):355–63.

Luqmani RA. State of the art in the treatment of systemic vasculitides. Front Immunol 2014;5:471.

Gamal SM, Mohamed SS, Tantawy M, Siam I, Soliman A, Niazy MH. Lupus-related vasculitis in a cohort of systemic lupus erythematosus patients. Arch Rheumatol 2021;36(4):595–692.

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