[Bullous eruption in systemic lupus erythematosus]

Area of Science:

• Dermatology
• Rheumatology
• Immunology

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease.
• Bullous eruptions are uncommon manifestations of SLE.
• Differentiating SLE-associated blistering diseases is clinically important.

Observation:

• A 39-year-old African American woman with diagnosed SLE presented with tense bullae on erythematous bases on forearms and oral mucosa.
• The patient experienced pruritus and blistering that healed with atrophy.
• Clinical criteria for SLE included malar rash, alopecia, photosensitivity, oral ulcers, arthralgia, fever, anemia, leukopenia, elevated ESR, and positive ANA.

Findings:

• Histopathology revealed subepidermal bulla formation with a perivascular inflammatory infiltrate containing lymphocytes and eosinophils.
• Direct immunofluorescence showed linear IgG deposition, while indirect immunofluorescence was negative for autoantibodies.
• High-dose prednisone induced clinical remission, but sulfone therapy was ineffective.

Implications:

• This case highlights a challenging bullous eruption in SLE that did not fit established classifications.
• The findings underscore the complexity of cutaneous manifestations in SLE.
• Further research may be needed to classify and manage such rare bullous conditions associated with SLE.