Systemic lupus erythematosus with vesiculobullous lesions. Immunoelectron microscopic studies

A 20-year-old man had systemic lupus erythematosus (SLE) and a skin eruption that consisted of pruritic, tense, clear, bullous, and vesicular lesions. Histopathological examination of the bullous lesions disclosed papillary microabscesses of neutrophils and subepidermal bulla formation. Direct immunofluorescence microscopy demonstrated linear bandlike depositions of IgA and IgG at the basement membrane zone in both peribullous and normal-appearing skin. By immunoelectron microscopy, the IgA and IgG deposits were found beneath the basal lamina, extending beyond the anchoring fibril zone into the deeper portion of the dermis. The immunoelectron microscopic features supported the conclusion that this patient had SLE with vesiculobullous lesions rather than SLE concurrent with dermatitis herpetiformis, linear IgA bullous dermatosis, or bullous pemphigoid. Oral dapsone therapy gave the patient dramatic relief from the cutaneous lesions, although he was unable to tolerate extended treatment with the drug.