A Case of Bullous Systemic Lupus Erythematosus with Ultraviolet-induced Exacerbation in Unexposed Area

Abstract

We report a 23-year-old man with systemic lupus erythematosus (SLE) with marked bullous lesions on his face, head and trunk. The biopsy specimen of bullous lesions revealed subepidermal blisters with neutrophil-predominant infiltration in the upper dermis. Direct immunofluorescence showed linear IgG, IgM and C3 depositions on the basement membrane zone and IgA around the hair follicles. Results of analysis of1M NaCl-split skin were negative. Based on immunofluorescence analysis, circulating autoantibody against type VII collagen was not detected in the serum. During his hospital stay the bullous lesions disappeared gradually. However, a few days after returning home, bullous lesions appeared on his upper trunk. This suggested that ultraviolet exposure might have induced the bullous lesions. Taking the clinical and pathological features together, this patient was diagnosed as having type 3 bullous SLE.