Severe bullous systemic lupus erythematosus successfully treated with low dose rituximab: A case report from Sub-Saharan Africa

Bullous systemic lupus erythematosus (BSLE) is a blistering skin condition occurring in lupus patients. Although cutaneous manifestations are common in lupus (59-85%), BSLE is rare, affecting <5% of lupus patients with very few reported cases among Africans. Dapsone is effective in mild to moderate cases, but off-label standard-dose rituximab (1,000 mg 2 weeks apart) has led to good outcomes in refractory cases. We report the case of a 39-year-old African lady with BSLE, who was successfully treated with low-dose rituximab (500 mg 2 weeks apart), healing her skin lesions at one year post-treatment. Low-dose rituximab may be as effective as standard dosing for the treatment of severe bullous SLE and is recommended in low resource settings.