Abstract
Bullous lupus erythematosus is an uncommon blistering subepidermal autoimmune disease with characteristic immunopathological nosologic features. A 67-year-old female presented with the sudden appearance of blisters in the upper area of the right chest. Skin biopsies stained with H&E favored the diagnosis of blistering lupus erythematous with a decrease in dermal sebaceous and eccrine glands. Direct immunofluorescence revealed deposits of IgG, complement C3, fibrinogen, IgM, and IgD in the epidermal corneal layer and the basement membrane zone. Reactivity to some dermal endothelial cell junctions and neural receptors was also noted. Also, complement C4 was positive against upper and middle dermal thin fibers. Complement D2 was positive around some enlarged dermal vessels, colocalizing with factor XIIIa. Our case highlights the complex and previously unreported immunologic response features associated with bullous lupus erythematosus.
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