LUPUS PERNIO - COMPLICATED BY CELLULITIS?
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I have a patient with longstanding lupus pernio, accompanied by upper airway
and sinus infiltrations. She has been on prednisone 30 mg q day for many
years.  One to two weeks ago she was started on methotrexate for crippling
arthritic involvement. She now has a periorbital cellulitis and eye pain
with ocular movement.  She is being hospitalized for parental antibiotics.
Is fungal involvement with mucor or other likely?  Has anyone else noted an
association of facial sarcoid and orbital cellulitis? If so- any
peculiarities to watch for?

Thank you.

Mary K. Cullen, M.D.
Washington Univ. School of Medicine
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I have not had sarcoid patients with orbital cellulitis, but have had two
patients with more localized abcesses, one on the middle of a forehead that
eroded through the frontal bone to the subarachnoid space, due to Cryptococcus.


Bryan R. Davis, M.D.
Department of Dermatology
Case Western Reserve School of Medicine
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