opportunity to learn Many diseases can cause tonic pupils

Many diseases can cause tonic pupils, such as diabetes, herpes, sarcoidosis, injury, infection, syphilis, Guillain–Barré syndrome, tumors, and HAS. We excluded all etiologies other than RS in our patient based on his history and the results of the physical and neurological examinations and laboratory and neuroimaging tests. The therapeutic options included video-assisted sympathectomy, iontophoresis, local instillation of botilinum toxin type A, and application of 0.005% glycopyrrolate aqueous cream. Vasudevan et al presented a case of a patient with ANA positivity who was treated with intravenous immunoglobulin. In our case, we treated the patient with botilinum toxin type A for his facial symptoms, but the treatment response was unsatisfactory for the patient. However, as botilinum toxin injections should be performed in a manner that does not affect the facial muscles, the doses used were low. The patient did not agree to injections of higher doses of botilinum toxin, as that could have affected the mimics.
Introduction Linear cutaneous lupus erythematosus (LCLE) is a rare subset of cutaneous lupus erythematosus (CLE), characterized by skin lesions that follow Blaschko lines. However, there are a variety of descriptions of lupus erythematosus (LE) lesions in these cases, including discoid LE and LE profundus among others. Although there is one case with other organ involvement that fulfilled the diagnostic criteria of systemic lupus erythematosus (SLE), cutaneous lesions are the only manifestation in most of the LCLE cases. In this paper, we presented a female patient with LCLE. We discussed the origin of Blaschko lines and summarized that CLE along Blaschko lines supports the functional role of opportunity to learn in the development of CLE.
Case report A 47-year-old female presented with a 2-month history of scattered pigmented macules over her right waist. The lesions were neither pruritic nor painful. She had neither trauma history nor associated symptoms. She had no known underlying systemic disease except thalassemia. A complete blood count showed microcytic anemia, compatible with thalassemia. The antinuclear antibody (ANA) was weakly positive (1:40). One month later, however, the pigmented lesions became scaly and papular, progressing toward the right lower extremity. The lesions were arranged in arch shapes on the right waist (Figure 1A) and in linear configuration on the right lower extremity (Figure 1B). A skin biopsy was performed. The histopathology showed atrophic epidermis with vacuolization of basal keratinocytes and papillary edema. Scattered dyskeratotic cells in papillary dermis were also found. There was inflammatory lymphocytic infiltration around the vascular structure and melanophages in the upper dermis (Figure 1C). Periadnexal lymphocytic infiltration was also observed (Figure 1D). The histopathologic findings were compatible with LE. Direct immunofluorescence revealed cytoid bodies with immunoglobulin G, immunoglobulin M, C3, and C4 depositions in the papillary dermis (Figure 1E). ANA was followed up and showed >1:1280 positive. Other autoantibody surveys showed anti-Ro positive (80.6 EliAU/mL, normal <7), anti-La negative, antiphospholipid immunoglobulin M and immunoglobulin G negative, and rheumatoid factor negative. The viral-infection survey showed negative for herpes simplex virus, varicella-zoster virus, and Epstein–Barr virus. Based on the clinical manifestation, histopathology, and autoantibody findings, subacute cutaneous lupus erythematosus (SCLE) along Blaschko lines was diagnosed. Because there were no systemic symptoms, topical treatment with 0.1% tacrolimus ointment was prescribed without oral medication. After a 5-month topical tacrolimus treatment, the skin lesions gradually resolved (Figure 2). The autoantibody survey was followed up again and showed ANA >1:1280 positive. The anti-Ro titer slightly decreased (51.3 EliAU/mL, normal <7) as compared to the previous anti-Ro titer. The topical treatment was continued, and the skin lesion resolved with complete clearance. No scaring or skin atrophy was noted. The total clinical course was 10 months.