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

A 56-year-old man with no prior risk factors presented with systemic lupus erythematosus (SLE) and digital gangrene as 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. Pulmonary tests indicated fibrosis and restrictive disease. Despite initial treatment with hydroxychloroquine, methylprednisolone, cyclophosphamide, and calcium blockers, the lesions persisted. Rituximab infusions led to significant improvement in vasculitis lesions and partial relief of dyspnea. This case highlights digital gangrene as a rare primary manifestation of late-onset SLE.