Lupus panniculitis as the initial presentation of systemic lupus erythematosus triggered by COVID-19 infection: case report and literature review

Abstract COVID-19 has many complications that affect many systems, including rheumatology and inflammatory skin conditions such as cutaneous lupus erythematosus. Herein, we describe the case of a patient with lupus panniculitis who presented with systemic lupus erythematosus in the setting of recent COVID-19 infection. A 66-year-old female patient presented to the hospital with expanded skin lesions all over her limbs, fever, joint pain, and fatigue. Lab tests and imaging revealed a second recent infection with COVID-19, positive titers of systemic lupus erythematosus antibodies, and biopsy confirmed lupus erythematosus panniculitis. She was treated with oral prednisone and hydroxychloroquine for SLE and symptomatic management for recent COVID-19 infection without ICU admission. Lupus erythematosus panniculitis (LEP) is a rare manifestation of lupus erythematosus. Although some cases of SLE following COVID-19 infection have been reported, lupus panniculitis as the initial presentation of systemic lupus erythematosus in these patients is extremely rare. Highlights Lupus panniculitis (LP) as the initial presentation of Systemic Lupus Erythematosus is uncommon. SLE diagnosis can be difficult in patients with COVID-19 infection because both have some common characteristics. Erythema nodosum is an important differential diagnosis for lupus erythematosus panniculitis.