Bullous SLE: response to methotrexate and relationship with disease activity

We report on a case of 40-year-old female with systemic lupus erythematosus (SLE) who developed a severe bullous eruption on sun-exposed areas. The bullous manifestation was associated with a flare of lupus serologies, whereas the previous manifestations of the disease were quiescent. Due to prior intolerance to many drugs, she was given oral methotrexate (10 mg=week). The drug administration was followed by a rapid and full resolution of cutaneous lesions. Five months later she developed a class III lupus nephritis. Our case is the first report of efficacy of methotrexate in bullous SLE and rises the question of the relationship between bullous eruption and SLE activity.

[1]  E. Sato.  Methotrexate therapy in systemic lupus erythematosus , 2001, Lupus.

[2]  T. Chen,et al.  Concomitant lupus nephritis and bullous eruption in systemic lupus erythematosus. , 1999, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[3]  E. Sato,et al.  Double blind, randomized, placebo controlled clinical trial of methotrexate in systemic lupus erythematosus. , 1999, The Journal of rheumatology.

[4]  R. Bauer,et al.  Management of cutaneous lupus erythematosus with low-dose methotrexate: indication for modulation of inflammatory mechanisms , 1998, Rheumatology International.

[5]  S. Gansauge,et al.  Methotrexate in patients with moderate systemic lupus erythematosus (exclusion of renal and central nervous system disease) , 1997, Annals of the rheumatic diseases.

[6]  J. Callen.  Bullous systemic lupus erythematosus: revised criteria for diagnosis , 1995 .

[7]  R. Briggaman,et al.  Bullous SLE: a phenotypically distinctive but immunologically heterogeneous bullous disorder. , 1993, The Journal of investigative dermatology.

[8]  C. Camisa.  Vesiculobullous systemic lupus erythematosus. A report of four cases. , 1988, Journal of the American Academy of Dermatology.

[9]  J. Fine,et al.  Bullous systemic lupus erythematosus: an unusual clinical course and detectable circulating autoantibodies to the epidermolysis bullosa acquisita antigen. , 1986, Journal of the American Academy of Dermatology.

[10]  R. Hall,et al.  Bullous eruption of systemic lupus erythematosus. Dramatic response to dapsone therapy. , 1982, Annals of internal medicine.