Piecing Together a Case of Bullous Systemic Lupus Erythematosus in a Boy: Turning to the Clinical Laboratory for Critical Clues

Abstract

Bullous systemic lupus erythematosus (BSLE) is a rare autoimmune blistering condition. A 10-year-old boy presented with generalized vesiculobullous skin eruptions and was initially diagnosed with bullous disease of childhood. Indirect immunofluorescence testing for antinuclear antibodies (ANA) was positive, with a homogeneous pattern and a titre of ≥1:640. His skin biopsy revealed the presence of subepidermal bullae with linear deposition of IgG and C3 along the basement membrane. Renal biopsy showed class III lupus nephritis. Our case illustrates that bullous skin lesion can be the initial presentation of SLE especially in children. Thus, a high index of suspicion and the right diagnostic tools are crucial to unmask the true diagnosis.