We present a case of an 11-year-old female with granulomatosis with polyangiitis (GPA) diagnosed one year prior to presentation, stage III chronic kidney disease (CKD), hypertension (HTN), obstructive sleep apnea (OSA), and chronic anemia who presented with headache, nausea, vomiting, and diplopia and was found to have idiopathic intracranial hypertension (IIH). IIH was reported in adults with GPA and for our knowledge has not been yet reported in pediatric cases of GPA.
Makvandi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objectives: Our aim is to identify the presence of serologically active clinically quiescent (SACQ) episodes in pediatric systemic lupus erythematosus (SLE) patients. We aim to identify serologic biomarkers associated with SACQ episodes and discuss risks and benefits of escalating treatments. Material and methods: We evaluated 25 pediatric SLE patients, 13 of whom experienced SACQ epis odes. Serologically active clinically quiescent was defined as two consecutive clinic visits without any clinical symptoms or clinical examination findings of a lupus flare with a clinical Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI2K) score of zero, but either elevated antids DNA antibodies or low complement (C3 and/or C4) levels. Results: Among the 13 patients who experienced a SACQ episode, there were a total of 24 episodes, with each patient experiencing 1-4 SACQ episodes. Erythrocyte sedimentation rate (ESR) was the most commonly elevated laboratory marker in a SACQ episode, followed by low hemoglobin lev els, and then elevated antidsDNA antibodies. Of the 17 episodes treated during a SACQ episode, 15 (88%) did not progress to a clinical flare within six months, while two did. Furthermore, of the 7 patients who were not treated during their SACQ episode, 2 (29%) continued to be SACQ without flare, whereas 5 led to a clinical flare within six months. Conclusions: Serologically active clinically quiescent episodes were identified in pediatric SLE pa tients, suggesting that the presence of SACQ is not limited to adults with SLE. Serologic markers such as increased ESR, hemoglobin, and elevated antidsDNA antibodies are preliminarily associat ed with pediatric SACQ episodes. Treating these SACQ episodes in pediatric SLE patients was less likely to lead to a clinical flare within six months when compared to not treating (p < 0.05). More research with a larger sample size is needed to define SACQ episodes, determine the prevalence in pediatric SLE patients, and establish SACQ treatment guidelines.
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