Clinical and laboratory features suggestive of childhood-onset systemic lupus erythematosus (SLE)

Clinical manifestations

Persistent fever

Fatigue

Anorexia

Weight loss

Arthralgia

Arthritis

Serositis (pleuritis, pericarditis, peritonitis)

Malar rash

Discoid rash

Alopecia

Oral and nasal ulcers

Photosensitivity

Lymphadenopathy

Peripheral edema

Central nervous system (CNS) features*

Laboratory findings

Persistent thrombocytopenia (platelets <150,000/mL)

Hemolytic anemia (Hgb ≤12 g/dL)^¶

Lymphopenia (lymphocytes <1500/mL)

Leukopenia (WBC <4000/mL)

Hematuria

Proteinuria

Hypocomplementemia (low C3 and C4)

Autoantibodies (ANA, anti-dsDNA, anti-Smith, anti-RNP, anti-La/SSB, aCL, lupus anticoagulant)

Elevated liver enzymes/hepatitis (not necessarily specific for SLE)

Increased ESR (but normal CRP, except in a few scenarios)

Other supportive features:

Hypergammaglobulinemia (IgG)

Hypoalbuminemia

SLE should be suspected in a child with any of these clinical or laboratory features.

Hgb: hemoglobin; WBC: white blood cell; ANA: antinuclear antibody; anti-dsDNA: anti-double-stranded DNA; anti-RNP: anti-ribonucleoprotein; anti-LA/SSB: anti-Sjögren's syndrome-related antigen B; aCL: anticardiolipin; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; IgG: immunoglobulin G.

* CNS features include headaches, cognitive impairment, psychosis (visual and auditory hallucinations, distortions), acute confusional state (resembling delirium), seizures, stroke, chorea, demyelination, idiopathic intracranial hypertension, mood disorders, anxiety disorders, and aseptic meningitis.^[1]

¶ Especially direct antiglobulin test (DAT) positive.

Reference:

The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 1999; 42:599.

Graphic 64565 Version 5.0

خرید پکیج

Clinical and laboratory features suggestive of childhood-onset systemic lupus erythematosus (SLE)