RS is a rare but distinct entity in rheumatology, and SLE presenting initially as EM-like lesions is quite uncommon (2). Our case was an example of a similar situation where SLE initially presented as an EM-like lesion.

Controversy has developed in recent years about whether to consider RS as an independent disease. Several investigators believe RS is a subtype of subacute lupus erythematosus, and clinical and histological distinctions between them are challenging due to variations in the histopathological changes. The pathological evaluation of the skin lesion might reveal EM and/or lupus erythematosus‐like manifestations (3). Similarly, the major pathological feature of our case includes both an EM and a LE lesion. Overall, in addition to being diagnosed with SLE and EM, our case fully meets the diagnostic criteria for RS.

The therapeutic regimen used for RS and the prognosis are similar to those of SLE or DLE that occurs alone. The majority of the reported cases showed a satisfactory response to corticosteroids with azathioprine, antimalarial drugs such as chloroquine or hydroxychloroquine, dapsone, or cyclosporine (10,12). Our patient was subsequently managed with hydroxychloroquine (200 mg once daily), prednisolone (1 mg/kg/day), steroid ointment, a proton pump inhibitor, and sunscreen cream after the diagnosis. Following the treatment, the skin lesions gradually resolve, as shown in figures 1, 2, and 3.

Our case is unique as the patient presented to us with features of EM, and on investigation, we found underlying systemic lupus erythematosus, thus SLE presenting for the first time as EM. Very rarely, SLE may initially present with recurrent episodes of EM‑like lesions. A high index of suspicion is needed for diagnosing RS, and it should be considered in all patients with LE with EM‑like lesions where there is no evidence of a precipitating factor. Early diagnosis and prompt treatment of RS are required to prevent irreversible complications.