Stevens‐Johnson syndrome/toxic epidermal necrolysis‐like acute cutaneous lupus erythematosus in a patient with systemic lupus erythematosus

Abstract

CORRESPONDENCEinterface dermatitis. 1 SJS/toxic epidermal necrolysis (TEN)-like acute CLE (ACLE), a hyperacute and severe form of CLE, is included in lupus erythematosus (LE)-specific vesiculobullous diseases. LE nonspecific vesiculobullous diseases include bullous SLE and other vesiculobullous skin disorders, such as autoimmune bullous disease, 2 SJS, and TEN. 3Rutnin and Chanprapaph 4 described that SJS/TEN-like LE occurs in patients with a history of recent onset or exacerbation of LE and usually starts in photodistributed areas, and mucosal involvement is absent or minimal. These characteristics were also observed in our patient. Histopathological findings of skin biopsy and subsequent clinical features, such as chilblain-like lesions and lupus nephritis, also supported our diagnosis. Romero et al. 5 reviewed TEN-like ACLE and mentioned that the diagnosis of TEN-like ACLE is often made retrospectively, after correlating the clinical course, serologic profile, and histopathology.When the patient has a history of prior culprit drug exposure or infectious disease, it is difficult to distinguish between SJS/TEN-like ACLE and SJS/TEN. Although an increased incidence of SJS/TEN in patients with SLE has been reported, Hsu et al. 6 found that individuals with SLE had an odds ratio of 5.34 for SJS and an odds ratio close to one for TEN. These reports suggest that patients with TEN-like ACLE are correctly identified, but SJS-like ACLE is still prone to be misclassified as SJS. We should take into consideration that ACLE may present with SJS-like findings when vesicular lesions are seen in SLE patients.