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Case Reports

Abstract

A 25-year-old female presented with annular lesions with raised pink-red borders and central clearing and erythematous plaques of varying sizes on her face, chest, and abdomen. Two of the lesions were biopsied. Microscopic examination of the lesion from the sternum revealed an interface dermatitis with basal layer vacuolization, necrotic keratinocytes, and a large subepidermal bulla with associated neutrophils. An underlying lymphohistiocytic inflammatory infiltrate was observed around the dilated blood vessels of the superficial plexus. Overall, these findings were consistent with a bullous lupus erythematosus. Microscopic examination of the second biopsy from the right chest revealed an interface dermatitis with numerous dyskeratotic keratinocytes with an overlying orthokeratotic stratum corneum. A perivascular lymphohistiocytic inflammatory infiltrate with associated melanophages was also observed in the superficial dermis. Dermal mucin was highlighted with colloidal iron staining. Overall, the findings in these biopsies were most representative of erythema-multiforme like lesions occurring in the setting of lupus erythematosus, suggestive of Rowell syndrome, which is an uncommon clinical entity classified as a subtype of chronic cutaneous lupus erythematosus. These erythema multiforme-like lesions occurring in lupus erythematosus are typically accompanied by immunological findings such as speckled antinuclear antibodies, anti-La antibodies, and a positive rheumatoid factor test. This syndrome predominantly manifests in the second to third decade of life, with a higher incidence in females. Treatment with steroids or immunosuppressive drugs typically yields a favorable response in most patients.