Case Report: Extensive Digital Gangrene as a Primary Manifestation of Late-Onset Systemic Lupus Erythematosus

This case report details a 56-year-old man with extensive digital gangrene as the primary symptom of late-onset systemic lupus erythematosus (SLE). Initial treatments with hydroxychloroquine, methylprednisolone, cyclophosphamide, and calcium blockers were ineffective, but subsequent rituximab treatment significantly improved vasculitis lesions and partially improved dyspnea. The report emphasizes the rarity and severity of digital gangrene as an initial SLE symptom and suggests rituximab as a potential treatment when other therapies fail, highlighting the need for early recognition and intervention in SLE-related vascular complications.