Abstract:

Discoid lupus erythematosus (DLE) is an autoimmune inflammatory dermatosis characterized by erythematous plaques with dyspigmentation, telangiectasias, and frequently scar formation. Histopathology of DLE classically shows an atrophic epidermis with interface vacuolar changes as well as periadnexal and perivascular lymphocytic infiltrate but rarely demonstrates xanthogranulomatous change. A 26-year-old Asian woman with a history of systemic lupus erythematosus (SLE) as well as class IV lupus nephritis and a 64-year-old Hispanic woman without prior lupus diagnosis were evaluated for plaques with dyspigmentation on the bilateral temples and occipital scalp, respectively. The biopsies from both patients demonstrated lipidized histiocytes positive for CD68 along with a perivascular and periadnexal lymphocytic infiltrate. Histopathology of the first case additionally showed increased interstitial mucin and the second case revealed basement membrane thickening, papillary dermal edema, and diminution and decrease in sebaceous glands. Xanthogranulomatous infiltrates on histopathology is a rare finding in cutaneous LE and has only been described twice previously in the literature. The mechanism for xanthogranulomatous change in cutaneous LE is not fully understood but has been hypothesized to occur secondary to chronic inflammation which in turn leads to epithelial cell injury, triggering the release of lipids that are then consumed by surrounding macrophages. These two cases provide additional evidence that xanthogranulomatous change, although rare, can occur in the setting of cutaneous LE and support the need for further investigation.

Financial Disclosure:
No current or relevant financial relationships exist.

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Kala Hurst, MS4, MS, BA