Refractory bullous systemic lupus erythematosus in a 14-year-old girl successfully treated with low-dose rituximab: A case report
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Abstract
Background. Bullous systemic lupus erythematosus (BSLE) is a rare vesiculobullous manifestation of systemic lupus erythematosus and is uncommon in paediatric patients.
Case presentation. A 14-year-old girl presented with pruritic vesiculobullous lesions involving the lips, neck, trunk, axillae and groin, accompanied by oral ulcers. Laboratory tests showed leukopenia, anaemia, elevated transaminases, low complement C3 and a high-titre antinuclear antibody (1:10 000). Histopathology revealed a subepidermal blister, and direct immunofluorescence demonstrated linear deposition of IgG, IgA, C3 and C1q along the dermoepidermal junction, confirming BSLE. After inadequate response to initial therapy, low-dose rituximab (100 mg) was administered, resulting in marked clinical improvement.
Discussion. Low-dose rituximab may provide effective disease control in refractory paediatric BSLE when conventional therapy is insufficient.
Conclusion. Low-dose rituximab can be considered an alternative therapeutic option for refractory paediatric BSLE.
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