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ACR Image Competition 2021 Results, Part 4

Marina Barguil Macedo, MD, MSc; Featured Image from Latin America & the Caribbean   |  Issue: June 2022  |  

Lichenoid Cutaneous Lupus Erythematosus Mimicking Acanthosis Nigricans

The photos depict a 45-year-old woman who presented to the Lupus Clinic of the University of São Paulo, Brazil, with lesions closely resembling acanthosis nigricans on her neck (A and B). The lesions had been present for four months.

The patient had lived with systemic lupus erythematosus (SLE) for 16 years, but had been in remission for four years. During the previous month, she had developed inflammatory arthralgias in her hands.

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Despite a body mass index of 33.7 kg/m2, she had normal fasting glucose (92 mg/dL) and normal glycated hemoglobin (5.5%). She had a low C4 level of 8.0 mg/dL (reference range: 10–38 mg/dL). Skin histopathology demonstrated evidence of vacuolar interface dermatitis (C and D), with IgM-reactive cytoid bodies on papillary dermis.

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Methotrexate was initiated, with topical tacrolimus for lichenoid lupus erythematosus.

Marina Barguil Macedo, MD, MSc, recently completed a residency in rheumatology at the University of São Paulo, Brazil.

About the Contest

The Rheumatology Image Library is a highly accessed teaching resource. However, images showing manifestations of rheumatic disease on skin of color are under-represented, creating a significant educational gap. The 2021 Image Competition, held in conjunction with ACR Convergence 2021, encouraged the global rheumatology community to submit images that will help healthcare providers identify rheumatic disease manifestations in skin of color.

Here, we depict the image featured from Latin America and the Caribbean. In coming issues, we’ll publish the winning images from other regions. The images judged Best Overall, People’s Choice and East Asia & Pacific Region appeared in previous issues.

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