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.