Refractory discoid lupus erythematosus responds to rituximab.

We present the case of a 56-year-old Caucasian man with longstanding, refractory discoid lupus erythematosus (DLE) with significant response to B-cell depletion therapy with rituximab. He was referred in 2012 with a chronic history of biopsy-proven DLE manifesting as erythematous scaly plaques and resultant scarring affecting the face, scalp, and neck. He was managed jointly with rheumatology but never displayed features of systemic lupus erythematosus (SLE). His antinuclear antibody titre was 1:160 with a speckled pattern; testing for renal disease, extractable nuclear antigen, double-stranded DNA and antiphospholipid antibodies was negative, and complement levels and inflammatory markers were normal. He had no other significant medical comorbidities but was an active cigarette smoker.