Lupus erythematosus panniculitis in a 77-year-old woman

Lupus erythematosus panniculitis (LEP) is an uncommon variant of lupus erythematosus, characterized by subcutaneous indurated nodules or plaques that often heal with lipoatrophy or scarring. We report a 77-year-old woman who presented with a 4-month history of painful subcutaneous nodules and erythematous plaques. She had a history of discoid lupus erythematosus in her 30s, which was successfully managed with topical treatments and had since resolved. Deep incisional biopsy of a plaque on her back confirmed the diagnosis of LEP. The patient improved with treatment including methotrexate, folic acid, and prednisone. This case highlights a unique clinical presentation of LEP, both in terms of patient age and lesion distribution, and underscores the critical role of histopathology in excluding subcutaneous panniculitis-like T-cell lymphoma.