Subacute Cutaneous Lupus Erythematosus in a Patient with Mixed Connective Tissue Disease

Mixed Connective Tissue Disease (MCTD) is an overlap syndrome of mild severity and good outcome. This disease consists of clinical features overlapping between Systemic Lupus erythematosus (SLE), scleroderma, rheumatoid arthritis, and polymyositis, in the presence of specific anti-RNP antibodies. We report a case of a 20-year girl who presented with a 3-month history of joint pains involving the small joints of her hands along with morning stiffness, skin thickening of hands, Raynauds phenomena, and recurrent photosensitive skin rashes. On examination, she had a maculopapular rash over her face, neck, and arms with skin tightening, acrosclerosis, and Raynauds phenomena of both hands along with clinical synovitis. She had positive anti-RNP antibodies, positive ANA and RA Factor with normal serum C3 and serum C4 with negative anti-DsDNA, anti-Ro, anti-La, anti-CCP, and anti-phospholipid antibodies. She was diagnosed as MCTD with subacute cutaneous lupus erythematosus (SCLE) and started on hydroxychloroquine and oral prednisolone. At 6 months follow-up, she was in remission and tolerating hydroxychloroquine without any adverse effects. Key Words: Mixed connective tissue disease, Anti-RNP antibodies, Subacute cutaneous lupus erythematosus, Skin biopsy.Mixed Connective Tissue Disease (MCTD) is an overlap syndrome of mild severity and good outcome. This disease consists of clinical features overlapping between Systemic Lupus erythematosus (SLE), scleroderma, rheumatoid arthritis, and polymyositis, in the presence of specific anti-RNP antibodies. We report a case of a 20-year girl who presented with a 3-month history of joint pains involving the small joints of her hands along with morning stiffness, skin thickening of hands, Raynauds phenomena, and recurrent photosensitive skin rashes. On examination, she had a maculopapular rash over her face, neck, and arms with skin tightening, acrosclerosis, and Raynauds phenomena of both hands along with clinical synovitis. She had positive anti-RNP antibodies, positive ANA and RA Factor with normal serum C3 and serum C4 with negative anti-DsDNA, anti-Ro, anti-La, anti-CCP, and anti-phospholipid antibodies. She was diagnosed as MCTD with subacute cutaneous lupus erythematosus (SCLE) and started on hydroxychloroquine and oral prednisolone. At 6 months follow-up, she was in remission and tolerating hydroxychloroquine without any adverse effects. Key Words: Mixed connective tissue disease, Anti-RNP antibodies, Subacute cutaneo