October 2005




A 28 year-old African-American woman with a history of systemic lupus erythematosus presents to the Barnes-Jewish emergency room with new blisters. The blisters initially began about 2 months prior to admission with a few on her face. She now notes increased blisters on her face, lips, neck, hands and feet over the last 5 days. Her medications are plaquenil, prednisone and Tylenol.

Physical examination:
Multiple tense bullae on normal and erythematous skin on her face, eyelids, lips, neck, arms, hands, dorsal feet, abdomen and pubic area. Multiple crusted erythematous plaques and erosions on her face, hands, feet and neck. She also had bullae and targetoid lesions on her palms and soles (Figures 1, 2 and 3).

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