மருத்துவ மற்றும் மருத்துவ வழக்கு அறிக்கைகள்

Renal Artery Thrombosis in a Boy as First Manifestation of Juvenile Systemic Lupus Erythematosus

Abstract

Sapountzi Evdoxia*, Staberna Alexandra, Davidhi Andjoli, Rafailidis Vasileios, Prassopoulos Panos, Stamou Maria and Galli-Tsinopoulou Assimina

Introduction: Systemic Lupus Erythematosus (SLE) is a complex autoimmune disorder with a wide spectrum of clinical manifestations. Though Antiphospholipid Antibodies (APAs) in SLE increase thrombotic risks, renal artery thrombosis is uncommon, especially in younger patients.

Case report: A 15-year-old presented with fever, chest pain, arthritis, and discoloured skin scars. During his hospitalization, he suddenly developed severe acute abdominal pain. Imaging findings revealed renal artery thrombosis at the site of an anatomical variation involving the bifurcating right renal artery. Clinical manifestations and laboratory tests ultimately led to the diagnosis of APA-positive Systemic Lupus Erythematosus (SLE). Treatment with Low-Molecular-Weight Heparin (LMWH), intravenous methylprednisolone at a dosage of 30 mg/Kg/d for three consecutive days, followed by oral prednisolone at a dosage of 1mg/Kg/d, hydroxychloroquine, and methotrexate, resulting in significant improvement. However, arterial hypertension emerged in the seventh week, requiring lisinopril. Six months later, the patient remains in remission with stable blood pressure.

Conclusion: To our knowledge, this is the first documented case of renal artery thrombosis initiating paediatric-onset APA-positive SLE. Thrombotic events should prompt consideration of systemic vasculitis.