6.ACUTE SLE-LIKE CUTANEOUS FLARE UNMASKING MIXED CONNECTIVE TISSUE DISEASE (MCTD) IN A 38-YEAR-OLD FEMALE: A CASE REPORT
ACUTE SLE-LIKE CUTANEOUS FLARE UNMASKING MIXED CONNECTIVE TISSUE DISEASE (MCTD) IN A 38-YEAR-OLD FEMALE: A CASE REPORT
Kanchan Kumari1, Archana Kumari2, FNU Hammad3, Kashaf Imtiaz3, Muhammad Husnain Ahmad4 1Liaquat National Hospital and Medical College, Karachi, Sindh, Pakistan 2Liaquat National Medical College, Karachi, Sindh, Pakistan 3Faisalabad Medical University, Faisalabad, Punjab, Pakistan 4Mujahid Hospital, Faisalabad, Punjab, Pakistan & 4Satkynbai Tentishev Asian International University, Kant, Kyrgyz Republic *Corresponding author
ABSTRACT
purpose: To describe a case in which an acute cutaneous flare mimicking systemic lupus
erythematosus (SLE) was ultimately diagnosed as mixed connective tissue disease (MCTD), and to
illustrate the diagnostic difficulty posed by overlapping autoimmune syndromes. Methods: Clinical evaluation, complete blood count, coagulation profile, 24-hour urine
protein, antinuclear antibody (ANA) testing with titer and pattern, and an extractable nuclear antigen
(ENA) antibody panel were performed on a 38-year-old woman presenting with a malar rash, joint
pain, mouth ulcers, and a seven-year history of fluctuating symptoms.
Results: The patient’s presentation, initially attributed to a medication-non-adherence SLE
relapse, was instead explained by a positive ANA at a titer of 1:5120 with a speckled pattern and a
positive anti-U1-snRNP antibody titer above 1:1600, together with overlapping SLE-, systemic
sclerosis-, and myositis-type features that met the 2019 MCTD diagnostic criteria. Treatment with
oral prednisolone, hydroxychloroquine, and topical agents produced partial remission. Conclusion: MCTD should be considered whenever SLE-like symptoms do not fully fit a
single connective tissue disease, particularly when Raynaud’s phenomenon, myositis, or esophageal
involvement are present. Anti-U1-snRNP testing is central to reaching the correct diagnosis and
guiding treatment.
