A rare case of butterfly target rash

Abstract

A 25-year-old female was admitted under Internal medicine for fever and anemia. The patient had a history of fever, joint pain, photosensitivity, and rash over the malar area of the face. On examination, the patient had targetoid lesions over the malar area of the face, ulcers in the oral cavity, and chilblain lesions. The presence of a targetoid lesion in association with features suggestive of systemic lupus erythematosus (SLE) raised suspicion of Rowell syndrome (RS). Further evaluation revealed pancytopenia, proteinuria, positive antinuclear antibodies, and RA factor, confirming our suspicion. RS is chronic cutaneous LE, wherein erythema multiforme occurs in the setting of LE. Heretofore, only 18 cases of RS have been reported from India. Our patient had targetoid lesions limited to the malar area of the face, which is not the characteristic malar rash of SLE. The patient also had a rare finding of chilblain lesions. This distinctive array of clinical and immunological features diagnostic of RS prompted us to present the case.

Keywords

• erythema multiforme
• rowell syndrome
• systemic lupus erythematosus