A Rare Case of Severe Skin Reaction to Mycophenolate Mofetil in Systemic Lupus Erythematosus with Lupus Nephritis

We report a rare case of a severe maculopapular rash following the initiation of mycophenolate mofetil MMF in a 13-year-old female adolescent who was diagnosed with systemic lupus erythematosus SLE and stage IV lupus nephritis. MMF an effective immunosuppressive agent selectively inhibits T and B lymphocyte proliferation and is known for its rapid onset and relatively mild side effect profile compared to other immunosuppressants. The patient was initially treated with intravenous and oral prednisolone along with hydroxychloroquine followed by introduction of mycophenolate mofetil two days later. Within 24 hours of starting MMF she developed an adverse event characterized by a maculopapular rash with blisters intense itching facial puffiness and swelling of the lips. High-dose steroids and discontinuation of MMF led to gradual improvement with complete resolution of symptoms within two days. The diagnosis of a druginduced eruption was supported by symptom resolution and a marked response to steroids. While common side effects of MMF include gastrointestinal disturbances and peripheral oedema severe skin reactions are infrequent. Given the overall prevalence of MMF use we present a rare case of generalised maculopapular rash caused by MMF. This case highlights the adverse event caused by MMF in the context of SLE and lupus nephritis underscoring the need for vigilant monitoring of patients receiving this treatment.