PReS-FINAL-2305: Erythema multiforme in a child with lupus - what's in a name?

Results A 16 year old girl diagnosed as lupus 2 months ago with fever, butterfly facial rash, mucositis and arthritis as the only clinical features and a strongly positive ANA, presented to us with a sub-acute (over 7 10 days), progressive photosensitive mucocutaneous eruption that was erythematous maculopapular, bullous with annular plaques distributed over the face, neck arms and legs, relatively sparing the scalp, palms and soles. Oral ulcers were present on the inside of the lower lip. She had high fever and significant constitutional features. There was no history of ingestion of any incriminating drugs. She was on low dose oral steroids and hydroxychloroquin at the time of presentation.At this stage her investigations revealed Hemoglobin of 8.4 gm/dl, Total WBC counts 12,680/cu. mm, platelet count 1,90000. CRP was negative.C3 levels were 28 mg/dl, but rheumatoid factor (RF), Anti Ro and Anti La antibodies were negative. She was started on pulse methyl prednisolone at a dose of 30 mg per kilogram body weight for 3 days which led to a rapid reduction of rash and constitutional symptoms. We discharged her on oral prednisolone (2 mg/kg) and azathioprine (2 mg/kg). On follow up at 4 weeks just days before this submission her skin lesions had almost cleared. She continues follow up and her updated status will be presented.