This 13 year old girl with systemic lupus erythematosus suddenly developed widespread hemmorrhagic bullae on her trunk and extremities several weeks ago. New bullae continued to appear as old lesions healed leaving post inflammatory hypopigmentation. The mucous membranes were spared. Blisters were not tender except when they ruptured and stuck to her clothing. A biopsy from the edge of a fresh vesicle showed a subepidermal blister with IgG and C3 on the dermal side of the basement membrane zone typical of epidermolysis bullosa acquisita. She was treated with tapering course of prednisolone and mycophenolate.
tense hemmorrhagic bullae, ruptured bullae, crusts and hypopigmented macules