Two Unusual Cases of Discoid Lupus Erythematosus Associated With Xanthomatized Macrophages

Amy Weiss, Eun Ji Kwon, Marit Kreidel, Ranon Mann, Jason A. Cohen, Yiang Hui, Mark I. Jacobson

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

We present 2 patients with chronic discoid lupus erythematosus (LE) associated with xanthomatized macrophages on light microscopic findings. Skin biopsies revealed hyperkeratotic and atrophic epidermis, vacuolar degeneration of the dermal-epidermal junction, thickened basement membrane, follicular plugging, and perivascular and perifollicular lymphohistiocytic infiltrate. Notably, large collections of lipid-laden histiocytes were observed within the subjacent dermis. The patients denied history of intralesional steroid treatment. The patients did not demonstrate any clinical or laboratory signs of hyperlipidemia, cholestasis, and diabetes mellitus and insipidus. Accumulation of lipid-laden foam cells in cutaneous LE is a rare phenomenon that has been reported in discoid LE and lupus panniculitis, each only once in the literature. It has also been described within lesions of various other dermatoses in patients without lipid, hepatic, or endocrine abnormalities. Its mechanism remains unclear, but it has been hypothesized that intracellular lipids released from degenerating cells contribute to lipidization of mononuclear scavengers. Xanthomatous infiltration in cutaneous LE is an unusual feature, and its presence may not necessarily signify an underlying metabolic disorder.

Original languageEnglish (US)
Pages (from-to)129-132
Number of pages4
JournalThe American Journal of dermatopathology
Volume42
Issue number2
DOIs
StatePublished - Feb 1 2020

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Dermatology

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