Bullous dermatosis and systemic lupus erythematosus in a 15-year-old boy

Abstract

A 15-year-old boy had a bullous eruption suggestive of bullous pemphigoid and established systemic lupus erythematosus (SLE). Direct immunofluorescence studies of the bullae and adjacent skin revealed the linear deposition of IgG and complement localized to the basement membrane zone. Indirect immunofluorescence examination of the serum failed to reveal circulating basement membrane zone antibodies. The differential diagnosis of the bullous eruption is reviewed, and the problem of diagnosis in cases of coexistent bullous disease and SLE is discussed.

Bullous Systemic Lupus Erythematosus as an Initial Manifestation of SLE

“…In their case, two episodes of vesiculobullous eruptions occurred along with proteinuria and microhematuria at a time of high lupus activity (C4<10 mg/dl), suggesting that the blistering is a sign of disease flare. In a number of cases, including ours, with an abrupt onset of a vesiculobullous eruption as an initial manifestation of SLE, lupus nephritis was diagnosed concomitantly or later in the course of the disease as described earlier (6, 18, 19). Lupus nephritis has also been documented in cases of BSLE during treatment of SLE (1, 27, 29, 31, 32).…”

“…Repeated serologic studies revealed that the patient fulfilled at least four of the ACR criteria for SLE. A 15‐year‐old boy reported by Jacoby first presented with a widespread bullous eruption which subsequently led to the discovery of concomitant lupus glomerulonephritis (6). An 18‐year‐old woman reported by Barton first presented with progressive blisters in her oral mucosa.…”

Bullous lesions as a manifestation of systemic lupus erythematosus in two Mexican teenagers

“…It appears in less than 5% of patients with SLE, either in isolation or in addition to other cutaneous manifestations [15]. This condition usually affects young females, with only eleven cases reported in children [3-13] until now.…”

Enfermedad cutánea ampollosa en el lupus eritematoso sistémico

“…Las lesiones de LESA usualmente no responden a altas dosis de glucocorticoides sistémicos (70,71), pero en algunos pacientes que no toleran la dapsona o no responden a ella se ha utilizado la combinación de altas dosis de glucocorticoides y azatioprina, aunque la resolución de las lesiones es más lenta (26,28,70,72,73) Aunque se ha utilizado con buenos resultados ciclofosfamida ( 28) sulfapiridina (42) y metotrexate (37), la experiencia con estas drogas es limitada. Recientemente se ha informado respuesta exitosa al tratamiento con mofetil-micofenolato (74,75) y rituximab (76) en casos refractarios.…”