History: A 45 year old African American female presented with worsening painful vesicles on the face and trunk for three months.
Past Medical History: GERD. Asthma. Allergic rhinitis.
Allergies: No known drug allergies
Family History: Not significant
Physical Exam: Tense bullae and erosions on trunk (Fig. 1), scalp, face, and arms, some arranged in an annular pattern (Fig. 2). Erosions on the oral mucosa were also present.
WBC: 9,900, Hemoglobin: 11.1, Hematocrit: 33.1, Platelets: 126,000, ANA: positive, 1:5120, speckled, SS-A ab: positive, SS-B ab: positive, Lupus anticoagulant: negative, Histone ab: negative, ds DNA ab:negative, HIV: negative.
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