Childhood subacute cutaneous lupus erythematosus associated with transaminitis

Abstract

symptoms, history, computed tomography and magnetic resonance imaging (MRI). Anti-NXP2 antibodies were detected using an in-house ELISA.Five of the patients with DM were positive for anti-NXP2 antibodies. The clinical and laboratory findings are summarized in Table 1. All five anti-NXP2-positive patients had facial erythema, and two (Patients 1 and 2) of them had subcutaneous inflammation.Patient 1 was a 37-year-old woman, who presented with erythema, swelling, pain and oedema of the left lower thigh. A punch biopsy of the erythematous plaque from the left lower thigh (Fig. 1a) revealed panniculitis with predominantly lymphocytic inflammatory infiltrates in the subcutaneous fat (Fig. 1b).Patient 2 was a 67-year-old woman, who presented with a 2-month history of muscle pain and of erythema on her face, neck, limbs and back. She had undergone gastrectomy for stomach cancer at 64 years old. Shorttau inversion recovery MRI showed subcutaneous inflammation underlying her upper-arm erythema (Fig. 1c,d).A recent study 3 on the cutaneous characteristics of 20 patients with anti-MJ/NXP2-positive myositis showed that patients with anti-MJ/NXP2 positivity frequently had peripheral oedema (35% P = 0.02) and calcinosis (37% P < 0.01). Although facial rash was frequently observed in that report, the anti-MJ/NXP2-negative group also frequently showed facial rash (80% vs. 82%, P = 0.52). 3 The recent paper by Chairatchaneeboon et al. reviewed 25 reported cases of DM-associated panniculitis, in which 20 cases were described with pathological panniculitis features. 4 Of these 20 cases with a description of the pathological features, 7 had calcinosis and 11 had a lobular panniculitis as the dominant panniculitis. Unfortunately, our punch biopsy pathology sample (Patient 1) was too small to identify a definite pattern of panniculitis. Recently, an interesting anti-MJ/NXP2-positive DM case was published, in which panniculitis around the calcinosis sites was detected by biopsy and fluorodeoxyglucose-positron emission tomography. 5 In our study, Patient 3 presented with calcinosis 12 years after DM onset. Anti-MJ/NXP2 antibody in patients with DM seems to be associated with frequent subcutaneous involvement, such as oedema and calcinosis. 3 Calcinosis is possibly caused by both chronic and strong subcutaneous inflammation, including panniculitis.