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JAMA Dermatology Clinicopathological Challenge
May 2017

Bullae and Atypical Target Lesions in a Young Woman

Author Affiliations
  • 1Texas Tech Health Sciences Center, Lubbock
  • 2UT Southwestern Medical Center, Dallas, Texas
JAMA Dermatol. 2017;153(5):461-462. doi:10.1001/jamadermatol.2016.4809

A 22-year-old woman with a history of systemic lupus erythematosus was readmitted with fever and a generalized eruption. Six days prior to this admission, she had been hospitalized for a photo-induced flare of acute cutaneous lupus erythematosus (ACLE). At readmission, she was febrile with a temperature of 101.5°F, and on examination, she had a worsening, exquisitely tender rash with several blisters across her right arm. Physical examination revealed erythematous plaques with superficial desquamation in the malar distribution of the face, nose, ears, and medial forehead (Figure, A), as well as bilateral extensor arms, chest, posterior neck, and upper back. Several large bullae were located on the right arm (Figure, B). Numerous flat and raised 2-zoned atypical targets with dusky centers were appreciated on the forearms, abdomen, back (Figure, C), thighs, legs, palms and soles.

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