PMC7657367_01
(A) Active bullous pemphigoid skin lesions. (B) Histological images in hematoxylin and eosin staining of skin lesion biopsy showing subepidermal blister with a mixed inflammatory infiltrate rich in eosinophils mostly localized in a superficial dermis (10x and 20x magnification, respectively). (C) Periodic acid-Schiff staining images of kidney biopsy showing mesangial hypercellularity; the vessels show a slight moderate reduction of the lumen for sclerosis and myointimal hyperplasia, and vasculitic aspects are not observed (20x and 40x magnification, respectively). (D) Improvement of skin manifestations after therapy.
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F1
In December 2016, because of the persistence of hypocomplementemia (C3 81 mg/dl, C4 9 mg/dl), proteinuria (3 g/daily) (SLEDAI 6), and BP lesions, the patient repeated skin and kidney biopsy, showing persistence of skin and kidney active inflammation (Figure 1).
Changes of SLEDAI, proteinuria, and blood parameters across disease course of patient with systemic lupus erythematosus and bullous pemphigoid. Graphs depict the dynamics of each parameter while receiving different therapeutic schemes. SLEDAI, Systemic Lupus Erythematosus Disease Activity Index; C3, fraction 3 of the complement; C4, fraction 4 of the complement; ESR, erythrocyte sedimentation rate; ACLA, anti-cardiolipin antibodies; antibeta2-GPI, anti-beta2 Glycoprotein 1 antibodies.
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F2
At the last clinical assessment, proteinuria was absent with normal complement levels (C3 91 mg/dl, C4 18 mg/dl) (Figure 2).