PMC10082637_01
A 21-year-old female diagnosed with severe BSLE and autoimmune hemolytic anemia. Multiple tense bullae on erythematous base at trunk and extremities.
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Physical examination revealed multiple tense vesicles on lips, hard palate, and scalp; multiple tense bullae on erythematous base at trunk and extremities, accompanied with erythematous desquamated plaques on the palms and soles (Figure 1).
Direct immunofluorescence, (a) mixed linear and granular deposition of IgG along dermo-epidermal junction (DEJ), (b) Granular deposition of IgM along DEJ and superficial blood vessel, (c and d) mixed linear and granular deposition the along DEJ and perifollicular granular deposition of C3.
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Direct immunofluorescence (DIF) illustrated mixed linear and granular deposition of IgG, IgA, and C3 as well as granular deposition of IgM along the dermo-epidermal junction, IgM deposition at superficial blood vessels, few cytoid bodies of IgM and IgA, and perifollicular deposition of C3 (Figure 2).
Improvement of BSLE after rituximab therapy. One month after 2 intravenous infusions of rituximab 1000 mg with a 2-week interval apart, most of the lesions healed with post-inflammatory hyperpigmentation.
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Most of the lesions healed with post-inflammatory hyperpigmentation within 1 month, as shown in Figure 3.