Case Report: Extensive digital gangrene as a primary manifestation of late-onset systemic lupus erythematosus

A 56-year-old man with no prior history of conditions typically associated with digital gangrene presented with systemic lupus erythematosus (SLE) and digital gangrene as one of the initial symptoms. He exhibited joint pain, hair loss, photosensitivity, mouth ulcers, malar rash, dyspnea, and digital pain. Laboratory tests showed lymphocytopenia and elevated C-reactive protein, with positive antinuclear antibodies. Despite initial treatment with hydroxychloroquine, methylprednisolone, cyclophosphamide, and calcium blockers, the lesions did not improve. However, after two infusions of rituximab, there was a significant improvement in vasculitis lesions and partial improvement in dyspnea. This case highlights digital gangrene as a rare primary manifestation of late-onset SLE.