Case Report: Extensive Digital Gangrene as a Primary Manifestation of Late-Onset Systemic Lupus Erythematosus

A 56-year-old man with late-onset systemic lupus erythematosus (SLE) presented with extensive digital gangrene, a rare initial symptom. Initial treatments with hydroxychloroquine, methylprednisolone, cyclophosphamide, and calcium blockers were ineffective. However, subsequent treatment with rituximab significantly improved vasculitis lesions and partially improved dyspnea. This case underscores the importance of recognizing unusual SLE manifestations and suggests rituximab as a potential treatment when standard therapies fail.