Vesiculobullous systemic lupus erythematosis - A case series

Vesiculobullous manifestations of systemic lupus erythematosus (SLE) are rare and diagnostically challenging. We report a case series of six female patients with SLE presenting with various vesiculobullous lesions. The first case showed a severe toxic epidermal necrolysis-like presentation with extensive epidermal detachment and mucosal involvement, necessitating aggressive treatment with high-dose corticosteroids, intravenous immunoglobulin, and cyclophosphamide. The remaining cases included classic bullous SLE (BSLE) with mucocutaneous involvement and antinuclear antibodies (ANA)-negative BSLE, including a rare presentation during pregnancy. All patients fulfilled ≥4 American College of Rheumatology criteria for SLE. Histopathology demonstrated subepidermal blistering, and direct immunofluorescence revealed deposition of multiple immunoreactants along the dermoepidermal junction, with a full-house pattern and strong C1q positivity in all cases. This series highlights the clinical spectrum of vesiculobullous SLE and emphasizes the diagnostic value of immunofluorescence, particularly in ANA-negative cases.