Images in Dermatology
Cutaneous Blisters in a Patient With Systemic Lupus Erythematosus
Lesiones cutáneas ampollosas en un paciente con lupus eritematoso sistémico
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"apellidos" => "Bellido Pastrana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital General Universitario de Ciudad Real, Ciudad Real, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones cutáneas ampollosas en un paciente con lupus eritematoso sistémico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 400 "Ancho" => 773 "Tamanyo" => 78132 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 37-year-old primigravid woman at 35 weeks of pregnancy was seen for a 20-day history of multiple inflammatory skin lesions on her upper chest wall and both breasts. She had a past history of systemic lupus erythematosus (SLE) with active kidney disease, positive antinuclear antibodies at a titer of 1/360, anti-double-stranded DNA, and anti-Ro, and she was on treatment with prednisone (15<span class="elsevierStyleHsp" style=""></span>mg/d), hydroxychloroquine (200<span class="elsevierStyleHsp" style=""></span>mg/d), azathioprine (100<span class="elsevierStyleHsp" style=""></span>mg/d), and methyldopa (500<span class="elsevierStyleHsp" style=""></span>mg/d). Over the following 3 weeks, the lesions spread to the upper third of her back and to her abdomen and limbs. Twenty-four hours after delivery, she presented a bilateral facial rash and widespread bullous lesions on the lateral aspect of both arms, upper chest wall (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), back (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B), and lower limbs, including acral regions. The Nikolsky sign was positive. Histology revealed a subepidermal blister and an inflammatory infiltrate with abundant neutrophils; direct immunofluorescence was positive for C3 and immunoglobulin G. She required combined treatment with mycophenolate (2<span class="elsevierStyleHsp" style=""></span>g/d) and 6 infusions of belimumab (10<span class="elsevierStyleHsp" style=""></span>mg/kg per infusion), with a rapid response following the first infusion and complete reepithelialization in the subsequent months, with no recurrence during follow-up. SLE is a disease with particularly varied cutaneous manifestations. Vesicular rashes are uncommon in the context of LE, but toxic epidermal necrolysis-type or exudative erythema multiforme-type lesions can develop, leading to a long list of differential diagnoses. Pregnancy and the puerperium can provoke a clinical deterioration.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Flores-Terry MÁ, Sánchez-Caminero MP, Boom RC-Cd, Pastrana DB. Lesiones cutáneas ampollosas en un paciente con lupus eritematoso sistémico. Actas Dermosifiliogr. 2017;108:870.</p>" ] ] "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 400 "Ancho" => 773 "Tamanyo" => 78132 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010800000009/v1_201711021004/S1578219017302676/v1_201711021004/en/main.assets" "Apartado" => array:4 [ "identificador" => "41141" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010800000009/v1_201711021004/S1578219017302676/v1_201711021004/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017302676?idApp=UINPBA000044" ]
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