Other relevant laboratory tests: ANF positive (speckled)
1:640. Anti-DNA (double stranded) 1:512 mid positive. SSB/La 6.065
Extended Clinical Course:
Click on the image for magnification
A further relapse followed at the beginning of May.
Targetoid and annular erythematous purpuric lesions were seen on the upper chest, arms, forearms, hands, thighs and legs.
Perniotic lesions with ulceration were seen on her fingertips.
Laboratory Examinations: ANF positive (speckled) 1:160.
Anti-DNA (double stranded) 2.133 high positive. SSB/La 6.335 mid
Histology, June 1996: At a further relapse at the beginning of June skin biopsies were taken from the right arm, from lesional and normal skin for histopathology and immunofluorescence. Histology (Dr. J.A. Posen): There is focal surface parakeratosis. The epidermis in areas shows some degree of basal degeneration and the upper dermis is edematous with an increase in vascularity and a patchy mild lymphohistiocytic infiltrate. Some pigmentary incontinence is present. No epidermal necrosis or isolated necrotic cells are identified. The histologic features are in keeping with a diagnosis of lupus erythematosus.
Immunofluorescence: (Dr. W. Grayson, The South African Institute for Medical Research). Direct and Indirect immunofluorescence of lesional and normal skin was essentially non-specific.
Response to treatment: The patient has been treated with different combinations of oral and topical corticosteroids and oral and topical antibiotics. she has improved whenever on treatement but has had several relapses. However the intervals between relapses are becoming longer.
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