The course of juvenile-onset systemic lupus erythematosus may vary, from rapid multiorgan involvement to insidious development mimicking different medical conditions. depressive disorder in adolescents poses considerable diagnostic difficulties due to the natural tendency to lowered mood in this age group. However, it may also be the manifestation of a systemic disease. We present a case of a 16-year-old female patient without any somatic symptoms in whom severe depression resistant to treatment was the preceding symptom of juvenile-onset systemic lupus erythematosus (jsLe). Because of isolated proteinuria and presence of antinuclear antibodies, renal biopsy was performed. Light microscopy showed only findings characteristic for membranous nephropathy. examination on electron microscopy showed characteristic tubuloreticular inclusions (Tris) which were crucial for making the diagnosis of systemic lupus erythematosus. The evaluation of renal biopsy specimens by electron microscopy could be a useful diagnostic step to confirm the diagnosis, especially in difficult cases where the criteria for sLe are not fully met. The association of mental symptoms with systemic lupus erythematosus and other autoimmune disorders is well documented. However, the increasing prevalence of depression in children and adolescents poses a risk of delaying the diagnosis of a systemic disease.
Introduction: Juvenile systemic lupus erythematosus (jsle) is an autoimmune disease that develops as a result of multi-level immune dysregulation, including the interferon pathway. nephropathy develops at an early stage and eventually affects 90% of patients. a renal biopsy allows one to classify lupus nephritis and determine the proper treatment. Biopsy assessment should be done not only in a light microscope but also in a transmission electron microscope (teM). its usage may reveal the presence of intracellular tubuloreticular inclusions (tris), considered as a morphological marker of interferon hyperactivity.Material and methods: renal biopsies of 10 children with jsle and nephropathy were analyzed in teM. the location, structure, and size of tris were assessed. demographic data, nephropathy manifestation, non-renal symptoms, and serological activity of lupus were analyzed.Results: all the patients were female with an average onset at 12.7 years of age and met sle criteria. nephropathy manifested with proteinuria (n = 10) and hematuria (n = 6). Glomerular filtration rate (GFr) was normal in all patients. in three children with early disease onset, it manifested with hematological disorders. tris were revealed in 7 biopsies, with the highest expression in the youngest children, with peripheral cytopenia, membranous glomerulonephritis, and lupus nephritis.Conclusions: demonstration of tris in renal biopsies of children with juvenile systemic lupus may confirm the diagnosis of lupus nephritis and is a sign of involvement of the interferon pathway at the early stage of the disease.
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