RS is a rare but distinct entity in rheumatology, and SLE presenting
initially as EM-like lesions is quite uncommon (2). Our case was an
example of a similar situation where SLE initially presented as an
EM-like lesion.
Controversy has developed in recent years about whether to consider RS
as an independent disease. Several investigators believe RS is a subtype
of subacute lupus erythematosus, and clinical and histological
distinctions between them are challenging due to variations in the
histopathological changes. The pathological evaluation of the skin
lesion might reveal EM and/or lupus erythematosus‐like manifestations
(3). Similarly, the major pathological feature of our case includes both
an EM and a LE lesion. Overall, in addition to being diagnosed with SLE
and EM, our case fully meets the diagnostic criteria for RS.
The therapeutic regimen used for RS and the prognosis are similar to
those of SLE or DLE that occurs alone. The majority of the reported
cases showed a satisfactory response to corticosteroids with
azathioprine, antimalarial drugs such as chloroquine or
hydroxychloroquine, dapsone, or cyclosporine (10,12). Our patient was
subsequently managed with hydroxychloroquine (200 mg once daily),
prednisolone (1 mg/kg/day), steroid ointment, a proton pump inhibitor,
and sunscreen cream after the diagnosis. Following the treatment, the
skin lesions gradually resolve, as shown in figures 1, 2, and 3.
Our case is unique as the patient presented to us with features of EM,
and on investigation, we found underlying systemic lupus erythematosus,
thus SLE presenting for the first time as EM. Very rarely, SLE may
initially present with recurrent episodes of EM‑like lesions. A high
index of suspicion is needed for diagnosing RS, and it should be
considered in all patients with LE with EM‑like lesions where there is
no evidence of a precipitating factor. Early diagnosis and prompt
treatment of RS are required to prevent irreversible complications.