Lepore L, Pizzul M G, Longo F, Pennesi M, Di Leo G
Clinica Pediatrica, Istituto per l'Infanzia Burlo Garofolo, Trieste, Italia.
Pediatr Med Chir. 1995 Sep-Oct;17(5):443-6.
We describe 11 cases of Systemic Lupus Erythematosus (SLE) with pediatric onset (10 females and 1 male). Mean age at onset was 10.9 years (range 3 to 16 years). Initial manifestations: cutaneous involvement in 7 cases, articular symptoms in 7 cases, renal involvement in 5 cases (proteinuria and/or microhematuria, or renal failure), pancytopenia in 3 cases. In 3 cases the onset of the disease was extremely sudden and severe: one patient had an intestinal infarct following mesenteric thrombosis associated with glomerulonephritis; another started with encephalopathy (deep coma, stage III); a third patient presented renal failure due to acute glomerulonephritis. At diagnosis all patients received systemic steroid therapy with the exception of one who had only a cutaneous involvement. The course of the disease is described. We underline that, in our series, it was rare for organs and systems, apart from the central nervous system, to be involved in exacerbations after initial onset of the disease. Six patients are presently asymptomatic or have only minor cutaneous and/or articular manifestations which are well controlled with low-dose cortisone therapy. Laboratory indices did not return to normal in any of the patients. In fact, in our series the disease doesn't appear to reach a complete remission, even many years after onset and no patient seems to be able to withdrawal the therapy at all. Our data confirm, according to other Authors, that the course of LES with paediatric onset is more severe than in adults.
我们描述了11例儿童期起病的系统性红斑狼疮(SLE)患者(10名女性,1名男性)。发病时的平均年龄为10.9岁(范围3至16岁)。初始表现:7例有皮肤受累,7例有关节症状,5例有肾脏受累(蛋白尿和/或镜下血尿,或肾衰竭),3例有全血细胞减少。3例疾病起病极其突然且严重:1例患者在发生与肾小球肾炎相关的肠系膜血栓形成后出现肠梗死;另1例以脑病(深度昏迷,III期)起病;第3例患者因急性肾小球肾炎出现肾衰竭。诊断时,除1例仅有皮肤受累的患者外,所有患者均接受了全身类固醇治疗。描述了疾病的病程。我们强调,在我们的系列研究中,除中枢神经系统外,疾病初始发作后器官和系统在病情加重时受累的情况很少见。6例患者目前无症状或仅有轻微的皮肤和/或关节表现,通过低剂量可的松治疗可得到良好控制。所有患者的实验室指标均未恢复正常。事实上,在我们的系列研究中,即使在发病多年后,疾病似乎也未完全缓解,而且没有患者似乎能够完全停用治疗。根据其他作者的研究,我们的数据证实儿童期起病的SLE病程比成人更严重。