Delayed onset of systemic lupus erythematosus in a child with endothelial tubuloreticular inclusion

We report here on an 11-yearold Japanese girl who was found to have protein uria by routine mass screening urinalysis for school children, and who deve loped systemic lupus erythematosus (SLE) 21 months later. The initial renal biopsy, performed 3 months after the first visit to Tokyo Medical Universi ty Kasumigaura Hospital (TMUKH), revealed membranous glomerulonephritis. In an immunofluorescent study IgG was the only positive immumoglobulin found. A " Full-house " immunofluorescence glomerulopathy, well known as a predic tive finding for lupus nephritis, was not detected. Endothelial tubuloretic ular inclusions (ETI) were found by electron microscopy. Because the diagno sis of SLE was not established clinically and serologically, the patient wa s followed every 3 months without drugs. Her urinary findings returned to n ormal within 18 months. Three months after the last visit, she was sent to Tsukuba University Hospital (TUH) for fever, arthralgia, dyspnea and butter fly rash. She was diagnosed as having SLE, pleuritis, and pericarditis. Alt hough she was treated with methylpredonisolone and oral prednisolone, she d eveloped cardiac tamponade on the 12th day of admission during the course o f pneumococcal septicemia. Finally, she was treated successfully with surgi cal procedures, antibiotics and oral prednisolone and was discharged. We co nclude that ETI is a more significant early sign of SLE than " full-house " inimmunofluorescence glomerulopathy, especially in pediatric cases.