Systemic lupus erythematosus in a Chinese woman presenting with gangrene of the fingers

Abstract

Gangrene is an uncommon and unusual manifestation of systemic lupus erythematosus (SLE). It usually occurs in the course of SLE; as a presenting feature it is even less common. A 33 yr old Chinese housewife with SLE presenting with gangrene of the fingers is described; the onset of the SLE was about three weeks before the onset of the gangrene. She also had periorbital swelling and fever. Raynaud's phenomenon was absent. Lupus erythematosus cells and the rheumatoid arthritis factor were present in the blood. The serum immunoglobulins showed a rise in the IgG and IgM and a fall in IgA levels. Sia's water test was negative and cryoglobulin was absent. Stellate ganglion block was of little benefit while prednisolone relieved the pain in the gangrenous fingers. After 3 months of prednisolone treatment the tips of the gangrenous fingers dropped off spontaneously. The literature of gangrene in SLE is briefly reviewed.