Pediatric systemic lupus erythematosus associated with autoimmune hepatitis and nephritic syndrome A case report and review of the literature

Abstract

Introduction: Systemic lupus erythematosus is an autoimmune disease that can affect multiple organs. Associated pathologies such as hepatitis and lupus nephritis are not frequent in the child population. Still, they lead to serious consequences with the risk of liver failure and chronic kidney disease, increasing morbidity and mortality in pediatric patients.

Clinical case: An 11-year-old male patient with a clinical picture characterized by: asthenia, hypoxia, epistaxis, pruritus, and marked jaundice, of four months of evolution, without an established diagnosis. Laboratory studies were requested that reported increased transaminases, proteinuria, ANAS, and AC. Positive DNA, imaging studies, and kidney and liver biopsy were also performed to clarify the diagnosis.

Evolution: Through a multidisciplinary clinical approach, and paraclinical and pathological examinations, the diagnosis of Systemic Lupus Erythematosus associated with Autoimmune Hepatitis and Lupus Nephritis was established. The patient remained in the Pediatric Intensive Care Unit with favorable evolution to treatment.

Conclusions: Pediatric Systemic Lupus Erythematosus associated with autoimmune hepatitis and lupus nephritis is a rare clinical presentation of which very few cases are reported worldwide. In its diagnosis, multidisciplinary clinical acumen, laboratory, imaging, and critical histopathological data should be highlighted to establish an opportune diagnosis with better prognosis and treatment and thus avoid fatal outcomes in pediatric patients.