Systemic lupus erythematosus with mucocutaneus and hematological manifestations associated with tinea capitis – case report

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune, inflammatory, chronic disease with multisystemic involvement. Approximately 15-20% of cases begin in childhood. The incidence in children is 2.2:100,000, the average pediatric age is 12 years. (1) Skin lesions are among the most common onset manifestations of SLE. According to the specialized literature, 74% of patients have lesions on the skin and 45% on the mucous membranes. (2) The presence of disseminated skin lesions and hematological changes is a major indicator of evolution towards SLE. (3) The diagnostic approach includes assessing the history of the disease in concordance with clinicalparaclinical examination. Determination of the autoantibody profile is the most useful tool in confirming SLE. Basic therapy includes photoprotection, synthetic antimalarials, corticosteroids, and immunosuppressive drugs. The study aimed to assess the multisystem involvement of lupus erythematosus in the pediatric population through the clinical case. Materials and methods We present the patient’s case to explain the issue. Result B.I. for 12 years, assisted in the dermatology department for mucocutaneous lesions without subjective sensations. A violaceous malar rash was determined on the face, cheeks, and nasal pyramid. At the level of the bilateral ear lobes, the anteroposterior thorax, and the extension faces of the upper limbs, there were well-demarcated erythematous-papular lesions without signs of infiltration and modest atrophy, covered by adherent pluristratified scales. Among other changes, an erythematous cheilitis was noted on the semi-mucosa of the lower lip. At the level of the oral cavity, subtle well-defined erosions were found on the surface of the hard palate. Another variety of lesions were identified on the scalp in the form of erythematous-scaly, round-oval plaques, with broken hairs a few mm from emergence, without signs of atrophy and follicular hyperkeratosis. The mycological examination of the hairs revealed Microsporum Canis, as well as pale green fluorescence on instrumental examination with Wood’s lamp. Hematological abnormalities such as anemia, leukopenia, and thrombocytopenia have been observed. Immunological changes detected: anti-ANA IgG positive titer 1:100, anti-SS-A/Ro60, anti-RNP-A, anti-RNP-C, anti-SmB, anti-SmD1- positive. Treatment with photoprotectors, synthetic antimalarials, corticosteroids and Griseofulvin led to a slowly favorable evolution of the mucocutaneous pathological process. Discussions According to specialized studies, the presence of disseminated skin eruptions, lesions on the semi-mucous and mucous membranes, and the positivity of anti-ANA, anti-dsDNA, and anti-Sm antibodies correlate with a high risk of evolution towards SLE. (3) Diagnostics in this case were established in the presence of 5 criteria: malar rash, disseminated discoid rash, oral erosions, hematological and immunological changes. Conclusions The relevance of the case is the rarity of SLE in a male child with an onset through disseminated skin-mucosal manifestations, the rapidly progressive evolution of the multisystemic involvement, and the simultaneous association with the scalp Microsporia.