Bullous systemic lupus erythematosus (BSLE) is a rare subset of systemic lupus erythematosus (SLE). We present a case of a 48-year-old hypertensive Filipino man, whose initial manifestation of SLE is a vesiculo-bullous eruption, possibly triggered by intake of irbesartan+hydrochlorothiazide with negative findings on anti native double stranded (ds) DNA, anti-Sm, anti-ribonucleoprotein (RNP), antiRo/SSA and anti-La/SSB, J0-1 antibody, antibody to histone and Scl 70 antibody but with persistently elevated anti-nuclear antibody (ANA) titers. Our patient fulfilled 3 out of 4 of Megahed's BSLE criteria which include: 4 of the American Rheumatism Association (ARA) criteria, skin punch biopsy and direct immunofluorescence (DIF), confirming our diagnosis. He responded well to corticosteroid and dramatically to dapsone. BSLE should be included as a differential diagnosis in bullous disorders and may be a presenting disorder of undiagnosed systemic lupus erythematosus.

Human ; Male ; Middle Aged (a Person 45-64 Years Of Age) ; Adrenal Cortex Hormones ; Antibodies, Antinuclear ; Biopsy ; Biphenyl Compounds ; Dna ; Dapsone ; Diagnosis, Differential ; Fluorescent Antibody Technique, Direct ; Histones ; Hydrochlorothiazide ; Lupus Erythematosus, Systemic ; Rheumatic Diseases ; Ribonucleoproteins ; Tetrazoles ; United States