Systemic Lupus Erythematosus with Hemorrhagic Bullae

The history of erythematosus (L. E.) truly began1in 1845 with the description by Hebra2of seborrhea congestiva, which in modern terminology would be classed as chronic (discoid) L. E. Cazenave,3in 1851, more fully defined this disease and named it lupus erythematosus. Prior to these definitive descriptions, cases of the chronic form were described by others under such titles as erytheme centrifuge by Biett4in 1828, flux sebace by Rayer5in 1827, and possibly even the case of ichthyosis facei by Bateman6in 1817. Systemic erythematosus, on the other hand, was described by Kaposi7in 1872. Although we have been unable to identify the earliest case recorded, bullous lesions in L. E. have been occasionally reported. Hardaway,8in 1889, described a patient with systemic erythematosus who demonstrated hemorrhagic crusts on the face (presumably preceded by bullae), and Gray,