Atypical presentation of systemic lupus erythematosus in a 16-year-old boy: Case report

##plugins.themes.academic_pro.article.sidebar##

Published Oct 8, 2024
https://doi.org/10.62438/tunismed.v102i10.5065
Download
pdf
Vol. 102 No. 10 (2024): Tunis Med oct 2024

##plugins.themes.academic_pro.article.main##

Hela Sahbani
Department of pediatric hematology, Aziza Othmana Hospital,Faculty of Medicine of Tunis,University of Tunis El Manar, Tunis, Tunisia.
Marwa Bahri
Department of pediatric hematology, Aziza Othmana Hospital,Faculty of Medicine of Tunis,University of Tunis El Manar, Tunis, Tunisia.
Emna Azza
Department of pediatric hematology, Aziza Othmana Hospital,Faculty of Medicine of Tunis,University of Tunis El Manar, Tunis, Tunisia.
Yosr Ben Abdennebi
Department of pediatric hematology, Aziza Othmana Hospital,Faculty of Medicine of Tunis,University of Tunis El Manar, Tunis, Tunisia.
Lamia Aissaoui
Department of pediatric hematology, Aziza Othmana Hospital,Faculty of Medicine of Tunis,University of Tunis El Manar, Tunis, Tunisia.

Abstract

Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, characterized by a clear female predominance and a major clinical polymorphism. Some initial presentations, particularly in children and adolescents are exceptional. Our objective was to report an unusual initial presentation of SLE in a male adolescent.


Observation: We reported the case of a 16-year- old tunisian boy who was referred to the hematology emergency department because of a hemorrhagic syndrome. The evolution was marked by pancytopenia, prolonged fever and an anasarca with recurrent cardiac tamponade. Explorations concluded to SLE. The patient was started on pulse therapy of dexamethasone followed by immunoglobulin. He was also provided with pericardiocentesis with a favorable outcome.


Conclusion: SLE is characterized by clinical polymorphism, that’s why diagnosis and management of complications could be difficult. SLE should be considered in differential diagnosis of many disorders, such as pancytopenia and cardiac tamponade

Keywords:

Cardiac Tamponade, Case Reports, Cytopenia, Pediatrics, Systemic lupus erythematosus

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Arnaud L, Amoura A. Systemic lupus erythematosus. EMC-Traité de Médecine Akos 2012;7(2):1-9 [Article 5-0260]
  2. Harry O, Yasin S, Brunner H. Childhood-onset systemic lupus erythematosus: a review and update. J Pediatr. 2018;196:22-30.e2.
  3. Tarr T, Dérfalvi B, Győri N, Szántó A, Siminszky Z, Malik A, et al. Similarities and differences between pediatric and adult patients with systemic lupus erythematosus. Lupus. 2015;24(8):796‑803.
  4. Gomez Casanovas J, Bartl M, Rincon-Rueda L, Loftis CE, Dulgheru E. At the heart of the diagnosis: a case of systemic lupus erythematosus presenting as cardiac tamponade. Cureus. 2023;15(1):e34447.
  5. Santacruz JC, Mantilla MJ, Rueda I, Pulido S, Rodriguez-Salas G, Londono J. A practical perspective of the hematologic manifestations of systemic Lupus Erythematosus. Cureus. 2022;14(3):e22938.
  6. Silva CA. Childhood-onset systemic lupus erythematosus: early disease manifestations that the paediatrician must know. Expert Rev Clin Immunol. 2016;12(9):907‑10.
  7. Novak GV, Molinari BC, Ferreira JC, Sakamoto AP, Terreri M, Pereira RMR, et al. Characteristics of 1555 childhood-onset lupus in three groups based on distinct time intervals to disease diagnosis: a Brazilian multicenter study. Lupus. 2018;27(10):1712‑7.
  8. Nusbaum JS, Mirza I, Shum J, Freilich RW, Cohen RE, Pillinger MH, et al. Sex differences in systemic lupus erythematosus: epidemiology, clinical considerations, and disease pathogenesis. Mayo Clin Proc. 2020;95(2):384‑94.
  9. Maharaj SS, Chang SM. Cardiac tamponade as the initial presentation of systemic lupus erythematosus: a case report and review of the literature. Pediatr Rheumatol. 2015;13(1):9.
  10. Umer A, Bhatti S, Jawed S. Sub-acute cardiac tamponade as an early clinical presentation of childhood systemic lupus erythematosus: a case report. Cureus. 2018;10(10): e3478.