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

    January 2024 in “ Faculty of 1000 Research Ltd ”
    Imad Uthman
    TLDR Digital gangrene can be an unusual first sign of late-onset lupus.
    This case report describes a 56-year-old man with extensive digital gangrene as a primary manifestation of late-onset systemic lupus erythematosus (SLE), which is rare. The patient had symptoms including joint pain, hair loss, photosensitivity, and dyspnea, with lab tests confirming SLE with lung involvement. Initial treatments with hydroxychloroquine, methylprednisolone, and cyclophosphamide were ineffective, but significant improvement was observed after administering rituximab, particularly in vasculitis lesions and dyspnea. The report underscores the complexity of SLE with digital gangrene and suggests rituximab as an effective treatment when other therapies are unsuccessful.
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