Lupus Erythematosus: Systemic with Skin Manifestations — MCQs

10 questions

Which of the following auto antibodies is most likely to be present in a patient with systemic lupus erythematosus?

Skin TB which involves skin after involving lymph nodes –

A 20-year-old female has an erythematous rash over her face on both cheeks and across the bridge of her nose. This rash is made worse by sunlight exposure when she is outdoors. Along with the rash, she has had muscle and joint pain for several months. However, radiographs of the joints do not show any abnormalities, and she has normal joint mobility without deformity. Which of the following laboratory test findings is most characteristic of the disease?

A lesion was seen on the face of a 42 year old patient as shown below. Which of the following would be ideal management for this condition?

A 26-year-old female patient presented with oral ulcers, sensitivity to light and rash over the malar area of the face sparing the nasolabial folds of both sides. Which of the following is most characteristic of this condition?

A patient with typical cutaneous lesions, slightly elevated red or purple macules often covered by gray or yellow adherent scales. Forceful removal of the scale reveals numerous ‘carpet tack’ extensions. The lesion is:

Lady presents with joint pain in both knees and low-grade fever, which occurs intermittently. On examination, she has a rash on sun-exposed areas. What is the clinical diagnosis?

A young patient presents to the clinic with erythematous lesions over the exposed areas of the skin like hands, arms, chest, etc. she also complaints of arthralgia and breathlessness. Which among the following antibodies will be useful in diagnosing this condition?

A 30-year-old female presents with a butterfly rash on her face, photosensitivity, and joint pain, and laboratory tests reveal positive antinuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies. What is the most likely diagnosis?

Q10

Acute febrile neutrophilic dermatosis is seen in-

Lupus Erythematosus: Systemic with Skin Manifestations Indian Medical PG Practice Questions and MCQs

Question 1: Which of the following auto antibodies is most likely to be present in a patient with systemic lupus erythematosus?

A. Antiphospholipid
B. Anti-Ro
C. Anti- ds DNA (Correct Answer)
D. Anti-RNP

Explanation: ***Anti-ds DNA*** - **Anti-double-stranded DNA (anti-dsDNA)** antibodies are highly specific for **Systemic Lupus Erythematosus (SLE)** and are included in the classification criteria [1]. - Their levels often correlate with disease activity, especially in cases with **lupus nephritis** [1]. *Antiphospholipid* - While **antiphospholipid antibodies** can be present in SLE patients (leading to **secondary antiphospholipid syndrome**), they are not the most characteristic or diagnostic autoantibody for SLE itself. - These antibodies are primarily associated with a **prothrombotic state** and recurrent miscarriages. *Anti-Ro* - **Anti-Ro (SSA) antibodies** are associated with SLE, particularly with **cutaneous lupus**, **neonatal lupus**, and **Sjögren's syndrome**, but they are not as specific as anti-dsDNA for the general diagnosis of SLE [1]. - Patients with anti-Ro antibodies may have a higher risk of **photosensitivity** [1]. *Anti-RNP* - **Anti-RNP antibodies** are found in patients with SLE, but they are most characteristically associated with **Mixed Connective Tissue Disease (MCTD)**. - Their presence in SLE often correlates with less severe renal involvement but may indicate **myositis** or **Raynaud's phenomenon**.

Question 2: Skin TB which involves skin after involving lymph nodes –

A. Scrofuloderma (Correct Answer)
B. Lupus erythematosus
C. Lupus pernio
D. Lupus vulgaris

Explanation: ***Scrofuloderma*** - This form of **cutaneous tuberculosis** results from the direct extension of underlying **tuberculosis** affecting structures such as **lymph nodes**, bones, or joints to the overlying skin. - The skin lesion often appears as an **ulcer** or **sinus tract** with **purulent discharge**, reflecting the underlying infection communicating with the surface. *Lupus erythematosus* - Lupus erythematosus is a systemic autoimmune disease that can affect the skin, but it is not a form of **tuberculosis**. - Skin manifestations range from acute malar rashes to chronic discoid lesions, which are distinct from **tuberculous ulcers**. *Lupus pernio* - This is a cutaneous manifestation of **sarcoidosis**, characterized by **violaceous plaques** and nodules typically on the face (nose, cheeks), ears, and fingers. - It is not a form of **tuberculosis** and does not result from the direct extension of an underlying local infection. *Lupus vulgaris* - This is a chronic and progressive form of **cutaneous tuberculosis** that directly affects the skin in individuals with high immunity to the **tubercle bacillus**. - It presents as **reddish-brown plaques** with an **apple-jelly** nodule appearance on diascopy, and does not typically arise from an underlying lymph node infection extending to the skin.

Question 3: A 20-year-old female has an erythematous rash over her face on both cheeks and across the bridge of her nose. This rash is made worse by sunlight exposure when she is outdoors. Along with the rash, she has had muscle and joint pain for several months. However, radiographs of the joints do not show any abnormalities, and she has normal joint mobility without deformity. Which of the following laboratory test findings is most characteristic of the disease?

A. Markedly decreased serum level of immuno-globulin G (IgG)
B. HLA-B27 genotype
C. Elevated anti-streptolysin 0 (ASO) titer
D. Antibodies to double-stranded DNA (Correct Answer)

Explanation: A 20-year-old female has an erythematous rash over her face on both cheeks and across the bridge of her nose. This rash is made worse by sunlight exposure when she is outdoors. Along with the rash, she has had muscle and joint pain for several months. However, radiographs of the joints do not show any abnormalities, and she has normal joint mobility without deformity. Which of the following laboratory test findings is most characteristic of the disease? ***Antibodies to double-stranded DNA*** - The patient's presentation with a **malar rash** (erythematous rash over both cheeks and the bridge of her nose) that is **photosensitive**, along with **arthralgias** and myalgias without joint deformity, is highly suggestive of **systemic lupus erythematosus (SLE)** [1]. - **Anti-double-stranded DNA (anti-dsDNA) antibodies** are highly specific for SLE [2] and are often associated with active disease, particularly lupus nephritis. *Markedly decreased serum level of immuno-globulin G (IgG)* - While **hypogammaglobulinemia** can occur in some autoimmune conditions or be a primary immunodeficiency, it is not a characteristic or typical finding in newly diagnosed or active SLE. - SLE is more commonly associated with **polyclonal hypergammaglobulinemia** due to chronic immune activation. *HLA-B27 genotype* - The **HLA-B27 genotype** is strongly associated with **spondyloarthropathies**, such as ankylosing spondylitis, reactive arthritis, and psoriatic arthritis, which primarily affect the axial skeleton and entheses. - This genetic marker is not directly associated with SLE and does not explain the patient's specific constellation of symptoms. *Elevated anti-streptolysin O (ASO) titer* - An **elevated ASO titer** indicates a recent infection with **Group A Streptococcus** and is primarily associated with **acute rheumatic fever** or **post-streptococcal glomerulonephritis**. - These conditions do not present with a photosensitive malar rash or chronic arthralgias in the manner described.

Question 4: A lesion was seen on the face of a 42 year old patient as shown below. Which of the following would be ideal management for this condition?

A. Topical retinoids
B. Oral steroids
C. Start on MDT for leprosy
D. Start on ATT (Correct Answer)

Explanation: ***Start on ATT*** - The presented image shows a **gummy lesion** on the face, which is characteristic of **tuberculosis cutis colliquativa**, a form of cutaneous tuberculosis. - **Anti-tubercular therapy (ATT)** is the primary and most effective treatment for all forms of tuberculosis, including cutaneous manifestations. *Topical retinoids* - Topical retinoids are primarily used for **acne vulgaris** and certain **disorders of keratinization** and are not indicated for infectious granulomatous conditions. - They work by **regulating cell growth and differentiation**, which is not the mechanism required to treat tuberculosis. *Oral steroids* - Oral steroids are **immunosuppressive** and generally contraindicated in active infections like tuberculosis, as they can worsen the disease. - While they might be used short-term in some inflammatory skin conditions, they would **not address the underlying tuberculous infection**. *Start on MDT for leprosy* - **Multi-drug therapy (MDT)** is the standard treatment for leprosy, which also presents with skin lesions and nerve involvement. - However, the image shows a **single, nodular, ulcerated lesion** more typical of cutaneous tuberculosis rather than the varied forms of leprosy (macular, papular, nodular lesions, or nerve thickening).

Question 5: A 26-year-old female patient presented with oral ulcers, sensitivity to light and rash over the malar area of the face sparing the nasolabial folds of both sides. Which of the following is most characteristic of this condition?

A. Butterfly rash sparing the nasolabial folds (Correct Answer)
B. Heliotrope rash on upper eyelid, bilateral hilar lymphadenopathy
C. Port-wine stain with CNS malformations
D. Silvery scales or plaques

Explanation: ***Butterfly rash sparing the nasolabial folds*** - The patient's presentation with oral ulcers, sensitivity to light (photosensitivity), and a rash over the malar area **sparing the nasolabial folds** is highly characteristic of **Systemic Lupus Erythematosus (SLE)**, a condition where a butterfly rash is a hallmark. - This specific distribution of the malar rash is a key diagnostic feature differentiating it from other facial rashes. *Heliotrope rash on upper eyelid, bilateral hilar lymphadenopathy* - A **heliotrope rash** on the upper eyelids is characteristic of **dermatomyositis**, which also presents with muscle weakness, not typically oral ulcers or a malar rash. - **Bilateral hilar lymphadenopathy** is a classic finding in **sarcoidosis**, a granulomatous disease, not directly related to the patient's symptoms. *Port-wine stain, CNS malformations: seen in Sturge-Weber syndrome* - A **port-wine stain** (nevus flammeus) is a congenital capillary malformation, often on the face, and is a principal feature of **Sturge-Weber syndrome**, which involves CNS malformations and seizures. - This condition has no association with oral ulcers, photosensitivity, or the described malar rash. *Silvery scales or plaques: seen in psoriasis* - **Silvery scales or plaques** are the characteristic dermatological lesions of **psoriasis**, a chronic inflammatory skin condition. - Psoriasis typically presents with well-demarcated erythematous plaques and is not associated with oral ulcers, photosensitivity, or a lupus-specific malar rash.

Question 6: A patient with typical cutaneous lesions, slightly elevated red or purple macules often covered by gray or yellow adherent scales. Forceful removal of the scale reveals numerous ‘carpet tack’ extensions. The lesion is:

A. Scleroderma
B. DLE (Correct Answer)
C. SLE
D. Lichen planus

Explanation: ***DLE*** - **Discoid lupus erythematosus (DLE)** lesions are characterized by **erythematous-to-violaceous plaques**, often with **follicular plugging** and a **firmly adherent scale**. - The "carpet tack" sign refers to the painful, prickly projections observed on the undersurface of a removed scale, indicating keratinous plugs within hair follicles, which is highly suggestive of DLE. *Scleroderma* - **Scleroderma** involves **fibrosis** of the skin, leading to hardening and thickening, often preceded by Raynaud's phenomenon. - It does not typically present with elevated red or purple macules with adherent scales or the "carpet tack" sign. *SLE* - **Systemic lupus erythematosus (SLE)** is a multi-system autoimmune disease that can have cutaneous manifestations, but these are often more diffuse (**malar rash**, photosensitivity) or non-scarring. - While DLE can occur in SLE patients, the description specifically points to the localized, scarring nature of DLE rather than the systemic features of SLE itself. *Lichen planus* - **Lichen planus** typically presents with **pruritic, polygonal, planar, purple papules and plaques** (the "6 Ps"). - While it can have scaling, it does not exhibit the "carpet tack" sign or the distinct follicular plugging seen in DLE.

Question 7: Lady presents with joint pain in both knees and low-grade fever, which occurs intermittently. On examination, she has a rash on sun-exposed areas. What is the clinical diagnosis?

A. Systemic lupus erythematosus (SLE) (Correct Answer)
B. Rheumatoid arthritis (RA)
C. Photodermatitis
D. Porphyria cutanea tarda

Explanation: ***Systemic lupus erythematosus (SLE)*** - The combination of **polyarthralgia (joint pain)**, **low-grade fever**, and a **photosensitive rash** is highly characteristic of SLE. [1] - SLE is a **multisystem autoimmune disease** that can affect joints, skin, and cause constitutional symptoms like fever. [1] *Rheumatoid arthritis (RA)* - While RA causes **joint pain**, it typically presents with **symmetrical polyarthritis** primarily affecting small joints, and a photosensitive rash is not a common feature. [2] - **Fever** can be present in severe RA, but the triad of symptoms in this case points away from RA as the primary diagnosis. *Photodermatitis* - **Photodermatitis** is a skin inflammation caused by sunlight exposure, resulting in a rash. - This diagnosis does not account for the **joint pain** or **low-grade fever**, which are systemic manifestations. *Porphyria cutanea tarda* - This condition primarily affects the skin, causing **photosensitivity**, blistering lesions, and increased fragility, especially on sun-exposed areas. - It does **not typically present with joint pain or fever**, differentiating it from the presented symptoms.

Question 8: A young patient presents to the clinic with erythematous lesions over the exposed areas of the skin like hands, arms, chest, etc. she also complaints of arthralgia and breathlessness. Which among the following antibodies will be useful in diagnosing this condition?

A. Anti-centromere antibodies
B. Anti-RNP antibodies
C. Anti-dsDNA antibodies (Correct Answer)
D. Anti-Scl 70 antibodies

Explanation: Anti-dsDNA antibodies - The clinical presentation with erythematous lesions in sun-exposed areas (consistent with photosensitivity [1] or malar rash), arthralgia, and breathlessness (suggesting serositis [4] or pulmonary involvement) is highly suggestive of Systemic Lupus Erythematosus (SLE) [3]. - Anti-dsDNA antibodies are highly specific for SLE and are included in the diagnostic criteria [4]. Their levels often correlate with disease activity, especially in lupus nephritis. *Anti-centromere antibodies* - These antibodies are typically associated with CREST syndrome (a limited form of systemic sclerosis), characterized by Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasias. - This clinical picture does not align with the patient's symptoms, which point more towards an inflammatory multi-systemic disease. *Anti-RNP antibodies* - Anti-ribonucleoprotein (RNP) antibodies are characteristic of Mixed Connective Tissue Disease (MCTD) [2], which features overlapping symptoms of SLE, systemic sclerosis, and polymyositis [3]. - While some features like arthralgia might overlap, the classic erythematous lesions and breathlessness are more directly linked to SLE in this presentation, and anti-dsDNA is more specific for distinguishing SLE. *Anti-Scl 70 antibodies* - Also known as anti-topoisomerase I antibodies, these are highly specific for diffuse cutaneous systemic sclerosis. - This condition is characterized by widespread skin thickening, interstitial lung disease, and other visceral organ involvement, which is not fully supported by the patient's primary symptoms of prominent erythematous rashes and isolated arthralgia.

Question 9: A 30-year-old female presents with a butterfly rash on her face, photosensitivity, and joint pain, and laboratory tests reveal positive antinuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies. What is the most likely diagnosis?

A. Rheumatoid arthritis
B. Systemic lupus erythematosus (Correct Answer)
C. Psoriatic arthritis
D. Dermatomyositis

Explanation: ***Systemic lupus erythematosus*** - The combination of a **butterfly rash**, **photosensitivity**, **arthralgia**, and positive **ANA** and **anti-dsDNA antibodies** is highly characteristic of systemic lupus erythematosus (SLE) [1]. - **Anti-dsDNA antibodies** are very specific for SLE and correlate with disease activity, especially **renal involvement** [1]. *Rheumatoid arthritis* - While it causes **joint pain**, it typically presents with **symmetrical polyarthritis** affecting small joints and lacks the hallmark skin manifestations like a butterfly rash [1]. - Serologically, **rheumatoid arthritis** is associated with **rheumatoid factor (RF)** and **anti-CCP antibodies**, not anti-dsDNA. *Psoriatic arthritis* - This condition is associated with **psoriasis**, manifesting as **scaly skin patches**, and can cause **arthritis**. - It does not typically present with a **butterfly rash** or the specific autoantibodies (ANA, anti-dsDNA) seen in this patient. *Dermatomyositis* - Characterized by **proximal muscle weakness** and distinct skin rashes such as **heliotrope rash** (purplish discoloration around the eyes) and **Gottron's papules** (reddish-purple papules over knuckles). - While it can involve **photosensitivity**, it does not typically present with a **butterfly rash** [1] or **anti-dsDNA antibodies**.

Question 10: Acute febrile neutrophilic dermatosis is seen in-

A. Behcet's syndrome
B. Sweet syndrome (Correct Answer)
C. Haberman syndrome
D. Kasabach-Merritt syndrome

Explanation: ***Sweet syndrome*** - Sweet syndrome is also known as **Acute febrile neutrophilic dermatosis**. - It presents with **fever**, painful erythematous plaques, and a prominent **neutrophilic infiltrate** in the dermis. *Behcet's syndrome* - Behcet's syndrome is characterized by **recurrent oral and genital ulcers**, uveitis, and skin lesions like **erythema nodosum** or **pathergy**. - It is a systemic vasculitis, not typically presenting as acute febrile neutrophilic dermatosis. *Haberman syndrome* - Haberman syndrome is better known as **Pityriasis lichenoides et varioliformis acuta (PLEVA)**. - It is a rare skin condition characterized by an acute eruption of **papules** and **erosions** that can resemble **chickenpox**. *Kasabach-Merritt syndrome* - This syndrome is a rare disorder involving **vascular tumors** (e.g., hemangiomas) that lead to profound **thrombocytopenia** and **consumptive coagulopathy**. - It does not present with acute febrile neutrophilic dermatosis.

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