Systemic lupus erythematosus Quiz: Ace Your Exams

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A 45-year-old woman comes to the clinic because of a rash that has been present the past two months. During this time, she has noticed red areas on her upper chest that slowly enlarge, then partially heal, leaving scar-like areas in the periphery. The patient has also been experiencing fevers and joint pains. Medical history is significant for primary essential hypertension, which is well controlled on amlodipine. She takes no other medications and has no allergies. The patient’s temperature is 36.7°C (98.0°F), pulse is 75/min, respirations are 14/min, and blood pressure is 115/75 mmHg. Physical exam shows discrete, erythematous, indurated plaques, covered with adherent scale, localized to the upper chest, as pictured:  

A close-up shows skin lesions with scabs and what appear to be blackheads or pores. The lesions are raised and some have a white, scaly appearance.

 Reproduced from: U.S. National Library of Medicine 
*Dark red spots are biopsy sites  

Biopsy histopathology shows hyperkeratosis, follicular plugging, and a mononuclear T-cell infiltrate. Which of the following is the most likely cause of this patient’s symptoms?  

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