Cutaneous Blisters in a Patient With Systemic Lupus Erythematosus.

A 37-year-old primigravid woman at 35 weeks of pregnancy was seen for a 20-day history of multiple inflammatory skin lesions on her upper chest wall and both breasts. She had a past history of systemic lupus erythematosus (SLE) with active kidney disease, positive antinuclear antibodies at a titer of 1/360, anti-double-stranded DNA, and antiRo, and she was on treatment with prednisone (15 mg/d), hydroxychloroquine (200 mg/d), azathioprine (100 mg/d), and methyldopa (500 mg/d). Over the following 3 weeks, the lesions spread to the upper third of her back and to her abdomen and limbs. Twenty-four hours after delivery, she presented a bilateral facial rash and widespread bullous lesions on the lateral aspect of both arms, upper chest wall (Fig. 1A), back (Fig. 1B), and lower limbs, including acral regions. The Nikolsky sign was positive. Histology revealed a subepidermal blister and an inflammatory