A Rare Case of Digital Ulceration and Gangrene as an Initial Presentation of Systemic Lupus Erythematosus in a Child

Abstract

Abstract Systemic lupus erythematosus (SLE) is an intricate autoimmune disorder that can manifest a plethora of symptoms. Tissue-binding autoantibodies and intricate immune complexes orchestrate the initial harm to organs and cellular structures. Amid its expansive array of manifestations, dermatological indications, notably digital gangrene and ulcers, are rare occurrences in the context of systemic lupus erythematosus and typically emerge in the advanced stages of the ailment. In this discussion, we present an exceptional case of early-onset digital gangrene and ulcers in a youthful patient grappling with systemic lupus erythematosus. This is a case study of a 7-year-old male who sought medical attention with urticarial rashes over his entire body and face, skin desquamation, and sporadic fever episodes. The preliminary assessment encountered challenges in distinguishing this presentation from acute urticaria. However, subsequent in-depth diagnostic scrutiny and serological analysis substantiated the patient's affliction with SLE. Digital gangrene, ulcers, and vasculitis became evident at the distal portions of the fingers. The diagnosis was conclusively established through clinical and serological methods. The patient exhibited positive results for antinuclear antibodies (ANA), anti-ribonuclear protein (Anti-RNP) antibodies, anti-Smith (Anti-Sm) antibodies, and anti-Sjögren's syndrome-related antigen A (Anti-SS-A) antibodies. This case underscores the pivotal importance of acknowledgment of the rare and severe manifestations of SLE in the realm of medical practice.