It has long been recognized that certain conditions of the skin are only a symptom of an underlying constitutional disturbance.
Osier1 in his papers published between 1895 and 1904 on the visceral manifestations of the erythema group of cutaneous diseases presented a series of 29 cases. He stated the belief that they represented one family which was characterized by the similarity of the conditions under which they occurred and the frequency with which the various cutaneous lesions were substituted one for the other in the same patient at different times. In this group the cutaneous lesions are essentially only a symptom of a severe underlying disturbance.
Libman and Sacks2 reported 5 cases of an unusual endocarditis, in 2 of which there were lesions resembling acute lupus erythematosus together with other erythematous eruptions. Their patients had had no previous organic symptoms. A summary of the observations were pericarditis, white
GOTSHALK HC, WAYSON JT. ACUTE ARTHRITIS ASSOCIATED WITH MYOCARDITIS SIMULATING ACUTE LUPUS ERYTHEMATOSUSREPORT OF A CASE. Arch Derm Syphilol. 1940;41(6):1053–1059. doi:10.1001/archderm.1940.01490120055007