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ISSN: 1734-1922
Archives of Medical Science
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vol. 13
Letter to the Editor

Henoch-Schönlein purpura in a pediatric patient with lupus

Peng Hu
Bao Yu Huang
Dong Dong Zhang
Guang Mei Jiang
Si Yan Liu
Xun Xia
Jie Cai

Arch Med Sci 2017; 13, 3: 689–690
Online publish date: 2017/04/20
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Systemic lupus erythematosus (SLE) is a chronic autoimmune connective tissue disease (CTD). It can involve multiple systems and lead to significant mortality. Of all cases, 10% to 20% occur in the first two decades of life, with an incidence of 0.3–0.9 per 100,000 children-years and a prevalence of 3.3–8.8 per 100,000 children [1]. Children suffering from SLE have a more aggressive clinical course when compared with their adult counterparts [2]. In addition, it has been reported that approximately 6% to 12% juvenile-onset SLE patients may develop other concomitant CTDs within a few months, such as juvenile idiopathic arthritis, dermatomyositis, polymyositis, scleroderma and Crohn’s disease [3]. In the present report, we encountered a pediatric patient who suffered from Henoch-Schönlein purpura (HSP) at 3 months after diagnosis of SLE.
A 9-year-old girl was first referred to our department in October 2014 for fever, facial butterfly erythema and polyarthralgia. The subsequent autoimmune and serologic workup came back positive for antinuclear antibody (ANA) at a titer of 1 : 3200, positive anti-double-stranded DNA (anti-dsDNA), anti-Smith antibody (anti-SM), and low complements C3 (0.21 g/l) and C4 (0.01 g/l). Her initial blood counts were as follows: white blood cells 2.54 × 109/l, red blood cells 3.27 × 1012/l, hemoglobin 87 g/l, and platelets 112 × 109/l. Other blood chemistry findings were erythrocyte sedimentation rate (ESR) 34 mm/h, C-reactive protein (CRP) 12 mg/l, and serum ferritin 559.90 µg/l. Urine analysis and renal function were normal. Based on the above clinical and laboratory findings, she was diagnosed with active SLE and treated with a course of pulse methylprednisolone 15 mg/kg/day for 3 days and subsequently converted to high-dose oral prednisone (2 mg/kg/day). After 7 days of hospitalization, the fever, facial butterfly erythema and polyarthralgia gradually resolved. Three months later, the patient presented to our department again with complaints of intermittent abdominal pain, hemafecia, and purpuric rash on her lower limbs (Figure 1). Laboratory analyses revealed leucocytosis (19.18 × 109/l), thrombocytosis (399 × 109/l) and an increased plasma level of immunoglobulin A (IgA, 4.24 g/l). The former high-titer ANA, positive anti-dsDNA and anti-SM, and hypocomplementemia were still existent. On these grounds, our patient was diagnosed as having SLE coexisting with HSP. After receiving the second course of pulse...

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