误诊为湿疹的儿童系统性红斑狼疮1例

A Case of Children Systemic Lupus Erythematosus Misdiagnosised as Eczema

患儿男,10岁。面部、躯干、四肢红斑3个月,曾按湿疹诊治,病情逐渐加重,伴发热1周。查体:全身多处骨骼压痛,伴腹痛、乏力、厌食,口唇糜烂,牙龈肿痛;颜面、耳部暗红斑疹,伴有糜烂、结痂,躯干、四肢散在分布红斑及瘀斑、瘀点,皮损较对称,局部有触痛、压痛,无显著瘙痒;血常规示三系细胞减低,尿蛋白(2+),抗核抗体、抗双链DNA、抗核小体抗体、抗组蛋白抗体均阳性。诊断:系统性红斑狼疮(活动期);狼疮性肾炎;多器官功能损害。予甲泼尼龙、环磷酰胺冲击治疗,皮损消退明显,脏器受累缓解。

A 10-year-old male with facial,trunk and limbs erythema for three month was diagnosed as eczema,and the condition gradually worsened with fever for one week.The physical examination showed bone tenderness,abdominal pain,fatigue and anorexia. The skin lesion showed lip erosion,gum swelling and pain and malar rash with erosion and scab. The skin of trunk and limbs showed symmetrical scattered erythema,petechia and ecchymosis,together with local pain but no significant itching. Laboratory test showed pancytopenia,urine protein( 2 +). ANA,dsDNA,anti-nucleosomes and anti-histones were positive. Diagnosis: systemic lupus erythematosus( active phase),lupus nephritis,and multiple organ dysfunction.With the treatment of methylprednisolone and cyclophosphamide,the lesions faded obviously and disappeared gradually and the organ damages were relieved.