title: Systemic lupus erythematosus and granulomatous lymphadenopathy.
abstract: BACKGROUND
  Systemic lupus erythematosus (SLE) is known to present with a wide variety of clinical manifestations. Lymphadenopathy is frequently observed in children with SLE and may occasionally be the presenting feature. SLE presenting with granulomatous changes in lymph node biopsy is rare. These features may also cause diagnostic confusion with other causes of granulomatous lymphadenopathy.
  
  
  METHODS
  We report 12 year-old female who presented with generalized lymphadenopathy associated with intermittent fever as well as weight loss for three years. She also had developed anasarca two years prior to presentation. On presentation, she had growth failure and delayed puberty. Lymph node biopsy revealed granulomatous features. She developed a malar rash, arthritis and positive ANA antibodies over the course of next two months and showed WHO class II lupus nephritis on renal biopsy, which confirmed the final diagnosis of SLE. She was started on oral prednisolone and hydroxychloroquine with which her clinical condition improved, and she is currently much better under regular follow up.
  
  
  CONCLUSIONS
  Generalized lymphadenopathy may be the presenting feature of SLE and it may preceed the other symptoms of SLE by many years as illustrated by this patient. Granulomatous changes may rarely be seen in lupus lymphadenitis. Although uncommon, in children who present with generalized lymphadenopathy along with prolonged fever and constitutional symptoms, non-infectious causes like SLE should also be considered as a diagnostic possibility.
authors.affiliation: Department of Pediatrics, KIST Medical College Teaching Hospital, Imadol, Lalitpur, Nepal. devendra.shrestha@gmail.com.
authors.forename: Devendra
authors.initials: D
authors.lastname: Shrestha
authors.forename: Ajaya Kumar
authors.initials: AK
authors.lastname: Dhakal
authors.forename: Raj K C
authors.initials: RK
authors.lastname: Shiva
authors.forename: Arati
authors.initials: A
authors.lastname: Shakya
authors.forename: Subhash Chandra
authors.initials: SC
authors.lastname: Shah
authors.forename: Henish
authors.initials: H
authors.lastname: Shakya
mesh_terms: D000974:Antibodies, Antinuclear / Q000097:blood; D002648:Child; D003240:Connective Tissue Diseases / Q000175:diagnosis; D003937:Diagnosis, Differential; D018450:Disease Progression; D004487:Edema / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D006099:Granuloma / Q000209:etiology* / Q000473:pathology; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D007239:Infections / Q000175:diagnosis; D007668:Kidney / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D008181:Lupus Nephritis / Q000209:etiology / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology*; D008206:Lymphatic Diseases / Q000209:etiology* / Q000473:pathology; D009369:Neoplasms / Q000175:diagnosis; D011239:Prednisolone / Q000627:therapeutic use; D011628:Puberty, Delayed / Q000209:etiology
chemical_list: D000974:Antibodies, Antinuclear; D006886:Hydroxychloroquine; D011239:Prednisolone