Safa BARIŞ, Elif AYDINER KARAKOÇ, Ahmet ÖZEN, Melissa KAÇMAZ, Medya NAMAR, Nurdan YILDIZ, Dilşat TÜRKDOĞAN, Işıl BARLAN

Early-onset neurolupus: A challenge for pediatricians

Sistemik lupus eritromatözis (SLE) çocukluk çağında nadir görülmesinin yanında, değişik klinik bulgular ile karşımıza çıkabilmekte ve bu nedenle tanı konulmasında zorluk yaşanmaktadır. Nörolupus erişkin hastalarda daha iyi tanımlanmış klinik tablo iken, çocuk yaş grubunda daha nadir olarak görülür. Beş yaşında kız hasta, yaygın makülopapüler cilt lezyonları, oral ülser, nöropsikiatrik semptomlar ile kliniğimize başvurdu. Antinüklear antikor (ANA), Anti-ds-DNA ve anti-histon antikor poztifliğinin yanında, kompleman değerlerinde düşüklük saptandı. Serum coxsackie ve sitomegalovirus (CMV) IgM testleri eş zamanlı pozitif bulundu. Kraniyal magnetik rezonans görüntüleme (MRG)de serebral ve serebellar atrofi gözlendi. Bu olgu sunumuyla, erken dönemde nörolojik bulgular ile SLEnin klinikte karşımıza çıkabileceği ve viral enfeksiyonların hastalığın patogenezinde rol alabileceği hatırlatılmak istenmiştir.

Erken başlangıçlı nörolupus: Pediatride zor tanı

Systemic lupus erythematosus (SLE) is a challenge for pediatricians due to the heterogeneity of its clinical manifestations and the rarity of the disorder in this age group. Neuropsychiatric SLE (NPSLE) was defined especially in adult patients and the clinical course of this manifestation is still not clearly defined in the pediatric age group. We, here report a five-year old girl presenting with extensive maculopapular skin lesions, oral ulcers and neuropsychiatric symptoms. She had elevated titers of anti-nuclear antibody (ANA), Anti-ds-DNA, anti-histone antibodies and complement levels. Serum coxsackie and cytomegalovirus (CMV) IgM tests were positive, as well. Magnetic resonance imaging (MRI) of the brain demonstrated extended cerebral and cerebellar atrophy. Pediatricians should be attentive to the possibility of neurolupus for patients with neurological problems despite a young age at presentation. Appropriate therapy is a challenging task.

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