History:

 

Patient of Dr 

13 y/o Aboriginal girl with History of SLE and lupus nephritis, with poor compliance with her medications (Prednisilone and Mycophenolate), presented to the rural hospital with ulcerated lips getting worse over 7 days, was thought initially to be Herpes simplex secondary to immunosuppression, PCR for Herpes sent off and patient commenced on IV Acyclovir, with poor response, Herpes PCR came back negative.

 

Patient was diagnosed with Bullous Lupus of lips, and commenced on topical steroids (diprisone 0.05%) with dramatic good response. Patient advised to keep away from sun and wear sun protections at all times, also educated about adherence to regular medication.