Tumid lupus: An unexpected diagnosis for the otolaryngologist

Abstract

Tumid lupus is an uncommon variant of lupus erythematosus. Patients present with subcutaneous lesions. Ophthalmic literature reports disease manifestation as orbital inflammation. Autoimmune serology is often negative. Without a high index of suspicion, the diagnosis is easily overlooked delaying treatment. Tumid lupus is not significantly discussed in the Otolaryngologic literature. Here we present a Case Report of a male who initially presented to Ophthalmology with unilateral orbital complaint of eyelid puffiness. Orbital biopsy and subsequent biopsy of his submental skin lesions ultimately led to this unexpected diagnosis. We discuss the method to diagnose tumid lupus including representative histopathologic findings.

Periorbital erythema and swelling as a presenting sign of lupus erythematosus in tertiary referral centers and literature review

“…7,12 Typically, most patients present with unilateral lesions (84% in our study and 80% in previous studies). 6–9,11,12 Additionally, it seems to present with left-side predominance (60% in the present and previous studies). The distribution of the rashes was more commonly restricted to the upper eyelid in our study (72%) and in previous case reports (50.0%).…”

“…23 However, occurrence of eyelid edema and erythema as a primary manifestation of LE is uncommon and difficult, with only a handful of related case reports ( Table 4). [5][6][7][8][9][10][11][12] The majority of patients with primary eyelid involvement tend to be female, with a proportion of 68% in our study and 90.0% in previous reports and an average age of 46.7 years and 38.5 years, respectively. Most patients (88%) had no prior history of autoimmune disease.…”

“…According to literature review, there were 10 patients with LE who reported primary presentations of periorbital erythema and swelling (Table 4). [5][6][7][8][9][10][11][12] Most of the patients were diagnosed with DLE (5 of 10, 50.0%), while three patients were diagnosed with tumid LE, one patient with lupus profundus, and one patient with LE with secondary Sjo¨gren syndrome. The majority of patients were female 90.0% (9 of 10).…”

“…4 While the manifestations of CLE are well established, ocular presentation with localized eyelid erythema and swelling is not well characterized and is frequently misdiagnosed. [5][6][7][8][9][10][11][12] To date, no largescale study on this unique presentation of CLE has been conducted. Therefore, in this study, we aimed to analyze the clinical characteristics, laboratory results, histopathological findings, and clinical courses of this unique presentation of CLE.…”

Periorbital swelling and episcleritis may be a sign of cutaneous lupus erythematosus

“…Periorbital edema is a rare presentation of CLE . A review of 77 patients with CLE and ocular findings by Arrico et al revealed that the main ocular site involved is the eyelids in 63 patients (88.7%) followed by orbit and periorbital tissues in six (8.4%) and cornea in two (2.6%).…”