PMC7594233_01
Urticarial vasculitic skin lesions of forearm, palms, and thigh.
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III lupus nephritis that transformed into to class IV in 2001 as well as positive antibodies for ANA, Anti ds-DNA, anti-Sm, and anti-Ro antibodies. In May 2013, while she was on remission of the lupus nephritis, presented with skin lesions over her body predominantly urticarial, non-pruritic (Figure 1), lasting for more than 24 hours, and healing with post-inflammatory hyperpigmentation.
Angioedema of lips.
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Several months prior to her skin manifestations she had 4 episodes of lip swelling her picture was suggestive of angioedema (Figure 2), not triggered by known medication such as ACE inhibitor.
Discoid lupus erythematosus of nose, ear, around eyebrow, and scalp.
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Six weeks later, she presented with severe discoid lupus erythematosus affecting her scalp, around the eyebrows, behind ears, and over nose (Figure 3).