Case Report
We present a 17-year-old female who was referred to us from the day care
unit for the management of bullous lesions that started to appear on her
abdomen 5 days prior. The patient was known to have Nephrotic syndrome
since the age of 1 year. Initially she had steroid dependent
Nephrotic syndrome for years and
had received fluctuating doses of systemic steroids for a long duration.
Later, she was diagnosed with steroid resistant nephrotic syndrome at
the age of 12.
Upon physical examination, she was found to have a cushingoid body
habitus, moon face, central obesity, abdominal striae and ascites. Rapid
weight gain was also noticed recently. There were multiple translucent
bullae along the striae distribution on her abdomen and extending to the
flanks as demonstrated in Figure 1 . The bullae were tender to
touch and filled with clear fluid.
Latest laboratory investigations showed typical features of nephrotic
syndrome; hypoproteinaemia (total protein 44 g/dL and Albumin 5 g/dL)
and abnormal lipid profile (Total cholesterol 6.9 mmol/L, LDL 4.01
mmol/L and Triglyceride 2.63 mmol/L). Additional laboratory findings
included anaemia (Haemoglobin (Hb) 9.0 g/dL), neutrophilic leucocytosis
(white blood cells 22.1 cells/mm3 and neutrophil 20.48 k/uL),
lymphopenia (1.00 k/uL), thrombocytosis (PLT
541*109/L), hypocalcaemia (Ca2+ 1.91
mmol/L), high microalbumin/creatinine ratio of 10380.9000 mg/g and
abnormal urine analysis (152 RBC / HPF). Fluid aspiration culture and
sensitivity was negative for the presence of bacteria and fungi, fluid
albumin level was 0.3, and white blood cells count was 42
cells\mm3. Skin punch biopsy of one of
the bullae with haematoxylin and eosin (H and E) stain revealed
oedematous dermis with relatively thinned horizontally oriented dermal
collagen. Table 2 summarizes the abnormal laboratory results.
These features supported the diagnosis of Bullous Striae Distensae.
Patient was treated with 80 mg Furosemide once daily for 14 days and the
bullae started to disappear slowly without any further intervention.