A 41-year-old woman with a history of systemic lupus erythematosus presented for evaluation of painful areas that had developed on her upper, outer arms and lateral thighs over the past month. She reported that, while the affected areas were initially smooth, some had begun to ulcerate. On examination, tender violaceous plaques and nodules with central crusted ulcers were seen. A skin biopsy revealed a lobular panniculitis with a lymphoplasmacytic infiltrate, hyalinizing fat necrosis, and lymphoid follicles.
Laboratory examination revealed a positive antinuclear antibody (ANA) and an elevated erythrocyte sedimentation rate (ESR).
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