LAUSR

A 14yearold girl, without any remarkable past medical history, presented with scattered round ulcers on the buccal mucosa, dorsal and lateral tongue (Figure 1), and gingiva for 4 months. Her lips were spared, and no Wickham striae were present. Similar ulcers were noted on the vulva. The remainder of the cutaneous examination was normal. Various medications, including oral dexamethasone, prednisolone, azathioprine, dapsone, hydroxychloroquine, and fluconazole were tried, but the ulcers showed no significant improvement. Investigation showed elevated erythrocyte sedimentation rate (48 mm/h; normal level <20 mm/h), elevated dsDNA antibody titers (70 IU/ml; negative <10 IU/ml), and negative antinuclear antibody titers. Buccal mucosa biopsy was obtained and sent for histopathological examination (Figures 2 and 3). Direct immunofluorescence (DIF) was inconclusive, but indirect immunofluorescence (IIF) was positive (Figure 4).