PMC6394362_01
BSLE. Arciform and linear tense bullae of varying sizes over erythematous macules and plaques on abdomen, thighs (A) and dorsum (B). BSLE = bullous systemic lupus erythematous.
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Skin findings showed the presence of a malar rash, and multiple tense vesicles and bullae varying from 1 mm to 6 cm, over erythematous macules and plaques (Figure 1).
BSLE. Skin histopathology. A - Subepidermal cleavage with neutrophils. The inflammatory cells are disposed along the papillary dermis; B - Subepidermal cleavage partially filled with neutrophils; C - Subepidermal blister with neutrophils and inflammatory cells at the periphery of the bulla; D - Neutrophils are present in the superficial dermis. Note the thickening of the basement membrane. (H&E, A:100X; B, C, and D: 400X). BSLE = bullous systemic lupus erythematous.
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Skin histopathology revealed subepidermal cleavage with a neutrophilic inflammatory infiltrate (Figure 2).
A - Direct immunofluorescence shows homogenous IgG deposit at the basement membrane zone (400X); B - Indirect immunofluorescence (salt-split skin), human foreskin substrate: IgG deposits at the dermal side of the split (400X).
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Direct immunofluorescence (DIF) showed positivity for IgG at the basement membrane zone (BMZ) in a linear pattern (Figure 3A). Salt-split skin indirect immunofluorescence showed the presence of IgG deposits at the dermal side of cleavage (negative for IgA and IgM) (Figure 3B).