title: Diversity in presenting manifestations of systemic lupus erythematosus in children.
abstract: OBJECTIVE
  To describe the diversity in presenting manifestations of systemic lupus erythematosus (SLE) in children.
  
  
  METHODS
  Initial clinical and laboratory manifestations of 39 children, who fulfilled >/=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 1:18.5, and racial/ethnic backgrounds were white 41%, black 33%, and Hispanic 26%. Initial manifestations included musculoskeletal 74%, cutaneous 72%, constitutional 67%, neurologic 28%, renal 28%, lymphadenopathy 15%, and Raynaud's phenomenon 10%. Laboratory abnormalities at presentation to our clinic included elevated erythrocyte sedimentation rate 87%, anemia 72%, lymphopenia 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%. One third (33%) presented with features not initially suggestive of SLE. Six patients presented with unusual manifestations including parotitis, quadriplegia, chorea, severe abdominal pain, persistent cough, and dizziness. However, 85% of patients with atypical manifestations had abnormal complete blood count or urinalysis results at presentation.
  
  
  CONCLUSIONS
  Presenting manifestations of SLE in children are diverse. A detailed history, thorough review of systems, complete physical examination, complete blood count, urinalysis, and a high index of suspicion help to make the correct diagnosis of SLE in patients with atypical presentations.
authors.affiliation: University of South Florida/All Children's Hospital, Departments of Allergy, Immunology and Rheumatology, St Petersburg, Florida 33701, USA.
authors.forename: S
authors.initials: S
authors.lastname: Iqbal
authors.forename: M R
authors.initials: MR
authors.lastname: Sher
authors.forename: R A
authors.initials: RA
authors.lastname: Good
authors.forename: G D
authors.initials: GD
authors.lastname: Cawkwell
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis*; D008297:Male; D012189:Retrospective Studies