Lupus erythematosus-specific bullous lesions: A case report

Rationale: Lupus erythematosus-specific bullous lesions (LE-SBL) is a rare cutaneous phenotype of lupus erythematosus, characterized by tense vesicles or bullae that readily mimic other primary bullous disorders. Patient concerns: A 79-year-old man presented with an abrupt onset of extensive tense bullae and erosions on the trunk, extremities, and oral mucosa, accompanied by pruritus and pain; no systemic involvement was detected. Diagnoses: Histopathology revealed a subepidermal blister with a predominantly lymphocytic infiltrate. Enzyme-linked immunosorbent assay for anti-type VII collagen antibodies was negative. Serologic studies demonstrated a markedly elevated anti-Ro-52 antibody titer (>500 U/mL) and a weakly positive antinuclear antibody (1:80, nucleolar pattern). A diagnosis of LE-SBL was established. Interventions: Intravenous methylprednisolone combined with oral hydroxychloroquine was administered, supplemented by symptomatic care. Outcomes: After systematic treatment, the patient’s blisters subsided and the eroded areas healed, with no new skin lesions observed during the follow-up period. Lessons: This study provides a comprehensive analysis of LE-SBL and further refines current understanding of the disease. Integration of histopathology, direct/indirect immunofluorescence, and serologic testing is essential to distinguish this entity from other bullous dermatoses. Early institution of glucocorticoids plus hydroxychloroquine achieves rapid disease control. This report offers an important reference for clinicians encountering similar cases.