Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2013 Nov 5:13:179.
doi: 10.1186/1471-2431-13-179.

Systemic lupus erythematosus and granulomatous lymphadenopathy

Devendra Shrestha  1 , Ajaya Kumar Dhakal, Raj K C Shiva, Arati Shakya, Subhash Chandra Shah, Henish Shakya
Affiliations
Case Reports

Systemic lupus erythematosus and granulomatous lymphadenopathy

Devendra Shrestha et al. BMC Pediatr. .

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.

Case presentation: 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.

Conclusion: 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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of diagnostic work up.
Figure 2
Figure 2
Photomicrograph of FNAC of a cervical lymph node. FNAC smear showing clusters of epithelioid cells in a lymphoid background (Wright stain, X100).
Figure 3
Figure 3
Photomicrograph of a cervical lymph node biopsy. Lymph node biopsy showing epithelioid granuloma admixed with eosinophils, lymphocytes and plasma cells (H&E stain, X40). Inset showing epithelioid granuloma in higher magnification (H&E stain, X400).
Figure 4
Figure 4
Photograph showing erythematous malar rash sparing nasolabial fold.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Nield LS, Kamat D. Lymphadenopathy in children: when and how to evaluate. Clin Pediatr (Phila) 2004;43(1):25–33. doi: 10.1177/000992280404300104. - DOI - PubMed
    1. Mok CC, Lau CS. Pathogenesis of systemic lupus erythematosus. J Clin Pathol. 2003;56(7):481–490. doi: 10.1136/jcp.56.7.481. - DOI - PMC - PubMed
    1. Teilum G. Miliary epithelloid-cell granulomas in lupus erythematosus disseminatus. Acta Pathol Microbiol Scand. 1945;22(1):73–79.
    1. Teilum G, Poulsen HE. Disseminated lupus erythematosus: histopathology, morphogenesis, and relation to allergy. AMA Arch Path. 1957;64(4):414–425. - PubMed
    1. Datta SK, Gandhi VC, Lee HJ, Pillay VK, Dunea G. Granuloma in systemic lupus erythematosus. S Afr Med J. 1972;46(41):1514–1516. - PubMed

Publication types

MeSH terms