Diversity in presenting manifestations of systemic lupus erythematous in children

Objective: To describe the diversity in presenting manifestations of system ic lupus erythematosus (SLE) in children. Study design: Initial clinical and laboratory manifestations of 39 children , who fulfilled greater than or equal to 4 American College of Rheumatology criteria for SLE, were retrospectively analyzed. Results: Median age at onset was 12 years. The male to female ratio was 1:1 8.5, and racial/ethnic backgrounds were white 41%, black 33%, and Hispanic 26%. Initial manifestations included musculoskeletal 74%, cutaneous 72%, co nstitutional 67%, neurologic 28%, renal 28%, lymphadenopathy 15%, and Rayna ud's phenomenon 10%. Laboratory abnormalities at presentation to our clinic included elevated erythrocyte sedimentation rate 87%, anemia 72%, lymphope nia 59%, leukopenia 31%, proteinuria or cellular casts 44%, low C-3 or C-4 level 77%, antinuclear antibodies 97%, and anti-double-stranded DNA 95%. On e third (33%) presented with features not initially suggestive of SLE. Six patients presented with unusual manifestations including parotitis, quadrip legia, chorea, severe abdominal pain, persistent cough, and dizziness. Howe ver, 85% of patients with atypical manifestations had abnormal complete blo od count or urinalysis results at presentation. Conclusion: Presenting manifestations of SLE in children are diverse. A det ailed history, thorough review of systems, complete physical examination, c omplete blood count, urinalysis, and a high index of suspicion help to make the correct diagnosis of SLE in patients with atypical presentations.