Ankle ulcer as a complication of systemic lupus erythematosus: A case report

Background: In 10-20% of cases, Raynaud’s Phenomenon (RP) is an initial manifestation of underlying connective tissue disease such as systemic lupus erythematosus (SLE), then Raynaud’s Phenomenon on SLE called secondary RP. Case presentation: A 26-year-old female came with pain in the fingers and toes. Pain aggravated by activity and cold temperatures. there are black-coloured changes at the tips of the toes, pale and bluish at bilateral fingertips. History of systemic lupus erythematosus since last 3 months. Physical examination revealed bilateral pale and cyanotic fingers, Black-colored sores on the right lateral malleolus, 1st and 5th toe of the right foot, 2nd and 3rd toes of the left foot. There is tenderness and pitting oedema. Peripheral pulses are not palpable. The antinuclear Antibody (ANA) profile is positive. Multislice computed tomography (MSCT) Angiography of the bilateral lower extremity was performed where there is stenosis proximal right dorsalis pedis artery, stenosis right plantar pedis artery, stenosis 1/3 medial left tibial posterior artery, and stenosis 1/3 distal left tibial anterior artery. The patient was diagnosed with secondary RP because of SLE and we performed debridement of the wound, then treated the patient with calcium channel blocker, prostacyclin analogue, antiplatelet and non-pharmacological treatment included avoiding cold exposure. Symptom resolution and ANA titer reduction are obtained at intervals of two- and six-months post-treatment. Conclusion: RP in this case is a manifestation of systemic lupus erythematous. Ulcer in the lateral malleolus area is a complication of secondary RP.