Systemic lupus erythematosus masquerading as gangrene - an infrequent presentation

Systemic lupus erythematosus (SLE) is an auto-immune disease affecting multiple organs. Among the cutaneous features, digital gangrene is considered to be very rare, occurring in only 1.3% of SLE patients. It is considered to be due to compromised perfusion of digits secondary to vasculitis, vasospasm and thomboembolism. This is the case report of a 35-year-old female who presented with acute blackish discoloration of toes of both feet associated with pain. She had no other features of SLE. But serology came out positive for SLE. The patient responded well to steroids, hydroxychloroquine, antiplatelet and anticoagulant medications and is currently under follow-up. This case report basically shows us that SLE should be considered as a possible differential diagnosis whenever there is a young patient presenting with digital gangrene without any other medical history.