Experience with anifrolumab in the treatment of lupus panniculitis

Abstract

One of the commonest manifestations of systemic lupus erythematosus (SLE) is skin damage. In addition to classic lupus erythema and subacute cutaneous lesion, deep damage to the subcutaneous fat, known as lupus panniculitis, can occur. The formation of subcutaneous nods, followed by atrophy, is not only a cosmetic issue but also indicates the presence of active immune inflammation. This phenomenon needs the attention of clinicians, as it requires careful differential diagnosis and aggressive disease-modifying therapy. The article presents a clinical observation demonstrating a rare skin manifestation of SLE – lupus panniculitis in a young patient with a SLE family history. The disease debuted in adolescence with a skin syndrome, which led to the initial diagnosis of discoid lupus. Subcutaneous nodes began to appear early on, and anti-nuclear factor (ANF) was positive. Subsequently, antibodies to native DNA were detected, and hematological and joint manifestations presented, what enabled the diagnosis of SLE two years after   onset, while the presence of panniculitis was not indicated in the diagnosis formulation. The standard therapy for SLE did not result in remission or low disease activity. Due to the persistent activity of SLE and the predominance of skin manifestations, the patient was treated with the biological drug anifrolumab. Combined therapy including anifrolumab led to a rapid regression of skin manifestations, lupus panniculitis was completely resolved, and activity decreased to the level of minimal. Thus, anifrolumab proved to be a highly effective therapeutic option in the treatment of lupus panniculitis.