Bullous SLE with varied presentation- A Case Series

Abstract

Abstract
Bullous systemic lupus erythematosus (BSLE) is a rare autoimmune blistering disorder associated with systemic lupus erythematosus (SLE), characterized by subepidermal bullae. In this study, we analyzed four cases of BSLE in female patients aged 19–56 years, with SLE durations ranging from 1 month to 2 years. Bullous lesions predominantly involved the trunk and extremities, presenting either initially or during the course of SLE. Cutaneous manifestations included non-scarring alopecia, palatal ulcers, and diverse lupus-specific rashes (ACLE, DLE, and SCLE). Systemic features varied, including lupus nephritis (class IV), neuropsychiatric SLE (NPSLE), pancytopenia, and macrophage activation syndrome (MAS). All cases showed high ANA titers, positive anti-dsDNA, and low complement levels. Treatment involved corticosteroids, hydroxychloroquine, and additional immunosuppressants like cyclophosphamide or mycophenolate mofetil. BSLE highlights the importance of recognizing its clinical spectrum, as timely intervention is crucial to manage associated systemic complications effectively.