A Rare Case of Bullous Lichen Planus in a Young Male Patient With Nephrotic Syndrome.

Lichen planus (LP) is a chronic, immune-mediated papulosquamous dermatosis that affects the skin, mucous membranes, and nails. Bullous LP (BLP) is a rare morphological variant characterized by the development of vesicles and bullae, either arising de novo or over existing LP lesions. We present a rare and noteworthy case of a young male patient with nephrotic syndrome who developed pruritic and painful bullous lesions. The initial clinical presentation was atypical and led to diagnostic uncertainty, with multiple differential diagnoses considered. However, histopathological evaluation ultimately confirmed the diagnosis of BLP. This case is of particular significance as it represents one of the first documented associations between BLP and underlying nephrotic syndrome with renal failure. The rarity of this presentation highlights the need for a high index of suspicion when evaluating bullous eruptions, especially in patients with systemic comorbidities. Accurate diagnosis through clinicopathological correlation, including histopathology and direct immunofluorescence, is essential for appropriate classification and management. This case contributes to the limited literature on BLP and emphasizes the importance of thorough evaluation in atypical dermatologic presentations.