New onset bullous lupus erythematosus in a systemic lupus erythematosus patient after initiation of hydroxychloroquin

We report a case of a 14-year-old Indian girl, a diagnosed case of systemic lupus erythematosus (SLE) who developed generalized erythematous rash and joints pain for 15 days. She was prescribed hydroxychloroquin and low dose deflazacort for joint pains. Within 3 days of initiation of hydroxychloroquin she developed generalized eruptions in the form of tense, fluid-filled blisters, erosions, and crusting. Biopsy showed subepidermal blistering with a prominent neutrophilic infiltrate. Direct immunofluorescence (DIF) showed positive granular immunoglobulin (Ig)G deposition with C3 and C1q at the dermoepidermal junction which was consistent with bullous SLE (BSLE). The lesions responded dramatically to dapsone 100 mg daily