A patient with acute-onset hemorrhagic necroses and bullae of the legs

A 30-year-old woman presented with sudden onset of large irregular shaped confluent hemorrhagic necroses, ecchymoses and bullae affecting both legs (Fig. 1A). Physical examination was otherwise unremarkable apart from a malar rash. Laboratory evaluation disclosed a high C-reactive protein level, thrombocytopenia, prolonged thrombin time and International Normalized Ratio, normal fibrinogen, elevated D-dimer levels and hypocomplementemia. Four years earlier, SLE had been diagnosed in the presence of malar rash, autoimmune hemolytic anaemia, hypocomplementemia and high-titer antinuclear and anti-dsDNA antibodies [1]. Antiphospholipid-antibodies and lupus anticoagulant have not been detected. The patient had been in remission under hydroxychloroquine treatment (cumulative dose 590  g) until her current admission.
Source: Rheumatology - Category: Rheumatology Source Type: research