Subacute Cutaneous Lupus Erythematosus in an 11-Year-Old Girl with Childhood-Onset Systemic Lupus Erythematosus: Adult Reference Intervals, Unscored Instruments and the Findings the Record Did Not Contain

Abstract

Background: Subacute cutaneous lupus erythematosus is an uncommon cutaneous expression of childhood-onset systemic lupus erythematosus, and paediatric reports usually describe morphology and treatment rather than the measurements on which severity is judged.

Objective: To describe paediatric subacute cutaneous lupus in skin of colour and to recompute, from the record alone, the classification, renal, nutritional and drug-exposure quantities it never derived.

Methods: One child's record over three assessments and 56 days was reviewed retrospectively and reported following the CARE guideline. Values were reproduced as printed; body surface area, estimated glomerular filtration rate, two nutritional indices, transaminase ratios, per-kilogram drug exposures, the 2019 EULAR/ACR score and the cutaneous activity and damage index were computed from them.

Results: An 11-year-old premenarchal Javanese girl presented with a seven-month photodistributed eruption of erythematous and hyperpigmented macules, papules and plaques on the face, neck, thorax, limbs and palms, with fever and weight loss. Antinuclear antibody was 1:10,000 fine-speckled and the erythrocyte sedimentation rate 124 mm/hour; nuchal biopsy showed interface dermatitis with vacuolar degeneration, Civatte bodies and pigment incontinence. A line immunoassay was positive for anti-Sm, anti-SSA/Ro, anti-SSB/La and anti-RNP/Sm. On topical treatment and photoprotection alone the cutaneous activity index fell from 18 to 4 by day 28. A creatinine of 0.84 mg/dL reported as normal corresponds to 69.2 mL/min/1.73 m² by the bedside Schwartz equation; the 2019 criteria total 10 points, never computed; the nutritional indices disagreed. No urinalysis, creatine kinase or complement was done.

Conclusion: Paediatric cutaneous lupus should be reported with its instruments scored and its reference intervals age-appropriate.