PMC7403923_01
Tense bullae over erythematous plaques on the trunk (a) and left upper extremity (b).
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Physical examination was notable for fever (temp 102.8 F/39.3 C) and clear fluid-filled bullae over the face, trunk, and extremities with crusting lesions on the lips, soft palate, and genitals (Figure 1).
Direct immunofluorescence with linear deposition of IgG and IgA at the basement membrane zone (a) and salt-split preparation with immune complex deposition at the dermal site (b).
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Direct immunofluorescence (IF) showed linear deposition of IgG and IgA at the dermal side with salt-split skin preparation consistent with BSLE (Figure 2).
Worsening blistering eruption on the abdomen.
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Despite aggressive treatment, new blistering lesions continued to appear on the face (at the vermilion border of the lips and the nasal bridge), trunk, abdomen, and limbs (Figure 3).
Hypopigmented macules on the trunk (a) and upper extremity (b) with no bullae lesions after seven months of treatment with dapsone.
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The skin lesions showed a marked improvement with only few hypopigmented macules on the trunk and upper extremities (Figure 4).