G143(P) More to a rash than meets the eye!. (May 2019)

• Record Type: Journal Article
• Authors: Pai, N; Barron, S; Wilkinson, N; Shivamurthy, V
• Is Part Of: Archives of disease in childhood. Volume 104:Supplement 2(2019)
• Page Start: A58
• Page End: A59
• Publication Date: 2019-05
• Subjects: Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2019-rcpch.139
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Introduction: Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease not very common in children and can have a variety of manifestations. Clinical manifestations in children are often atypical. Skin manifestations are one of the most common presentations, but these can be perplexing too. Case report: A 10 year old Afro-Caribbean girl, who was previously well presented a year ago to a local hospital with intermittent fever, migratory arthralgia and matted cervical lymphadenopathy. Fine needle aspiration cytology of her lymph nodes showed granulomatous changes. ESR was 105 mm/hour and CRP 27 mg/L. She later developed an eczematous non-photoeruptive rash initially on face and forearms followed by back and chest. She was treated with emollients and topical steroids. The rash however would wax and wane with post inflammatory hyperpigmentation. As the lymph nodes persisted, excision biopsy was done which showed no granulomatous changes. A joint review with dermatology and rheumatology was held and a skin biopsy performed, which showed features suggestive of an inflammatory connective tissue disease. Immunological markers revealed ANA (1:160–1:640) with a speckled and chromosomal pattern, anti-Sm and SSA (Ro60) positive. dsDNA was however, negative. Infectious work up including Tuberculosis and sarcoidosis screen were negative and her Echocardiogram was normal. Conclusion: Rash in childhood lupus may not always be typical. Rash in the context of systemic manifestations like fever, arthralgia or lymphadenopathy should raise a high index of suspicion for lupus. Also, fine needle aspiration is not always accurate for tissue diagnosis, making excision biopsy a necessity.