Bullous systemic lupus erythematosus.
A 19-year-old woman with a 6 month history of systemic lupus erythematosus (SLE) developed a widespread urticated, erythematous eruption associated with tense, fluid-filled blisters, erosions and crusting. Biopsy showed subepidermal blistering with a prominent neutrophilic infiltrate. Direct immunofluorescence showed markedly positive granular IgG deposition with weak IgM, IgA and C3 at the dermoepidermal junction. No circulating antibodies were detected on indirect immunofluorescence. A diagnosis of bullous systemic erythematosus was made. Treatment with prednisone was ineffective. Subsequent treatment with dapsone led to rapid sustained remission of skin symptoms. Bullous SLE is a rare manifestation of SLE. We review the recent literature and discuss the distinctive features of this condition and contrast them with cutaneous SLE with blisters and the subepidermal blistering disorders.
Yung
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Department of Dermatology, Waikato Hospital, Hamilton, New Zealand. ayung@ihug.co.nz
Oakley
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A
D000328:Adult; D001707:Biopsy, Needle; D003622:Dapsone / Q000008:administration & dosage; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000188:drug therapy; D011239:Prednisolone / Q000008:administration & dosage; D012872:Skin Diseases, Vesiculobullous / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology
D003622:Dapsone; D011239:Prednisolone