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Severe thrombocytopaenia induced by systemic lupus erythematosus presenting as haemorrhagic oral bullae in a paediatric patient
  1. Alec Giakas1,
  2. Katherine Holder2,
  3. Bernardo Galvan2 and
  4. James Stallworth1
  1. 1Department of Pediatrics, University of South Carolina School of Medicine, Columbia, South Carolina, USA
  2. 2Department of Internal Medicine, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas, USA
  1. Correspondence to Bernardo Galvan; bernardo.galvan{at}


Systemic lupus erythematosus (SLE) is an autoimmune disease with varying dermatological findings. We review a unique presentation of SLE with a literature review. A previously healthy early adolescent female presented with painful, oral mucosal bullae filled with sanguineous fluid. She endorsed a tender right knee, but examination revealed no additional abnormalities. CBC demonstrated severe pancytopaenia. Further workup, including Coombs positive RBCs and positive ANA, anti-Smith, and anti-dsDNA antibodies, confirmed Lupus as the aetiology of this patient’s presentation. A form of blistering SLE and resultant thrombocytopaenia was likely responsible for the patient’s oral manifestations. After receiving 60 g intravenous immunoglobulin and 3 days high-dose pulse corticosteroids, her dermatological symptoms resolved. Although cases of blistering SLE with mucosal bullae have been described in the literature, this is the first documented case of haemorrhagic mucosal bullae as the presenting symptom of thrombocytopaenia in SLE in a paediatric patient.

  • Systemic lupus erythematosus
  • Mouth
  • Paediatrics
  • Dermatology

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  • Contributors AG and JS contributed to planning. AG, KH and BG contributed to manuscript preparation. AG, KH, BG and JS contributed to manuscript revisions. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.