PULMONARY INVOLVEMENT IN
CHILDREN WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Reynés MJ, León RC, Carbajal RL,
Rodríguez HR, Barrios FR, Zarco RJ
Instituto
Nacional de Pediatría SS
Mexico
City. Mexico
Objective.
To
ascertain the incidence and the main pulmonary manifestations of systemic
lupus erythematosus (SLE) in children.
Material
and Methods. The clinical files of children with SLE studied from 1973 to 1992
were analyzed. The diagnosis of SLE was based on the criteria of the
American College of Rheumatology.
Results. There were 21 females
and 6 males, a 3.5:1 ratio. Age range was 6 to 17 years with an average of
13 years. Respiratory symptoms were: cough 8/11; chest pain, 3/11;
hemoptysis, 1/11; labial cyanosis, 3/11; diminished amplexion and
amplexation; sibilant rales, 1/11. Respiratory distress was present,
dyspnea, 8/8; polypnea, 3/8; intercostal retraction, 2/8. Chest X rays: the
most common primary changes were lupus pneumonitis in 8/16 patients;
interstitial infiltrate, 7/16; pleural effusion, 4/16; Respiratory function
tests in three of them showed a restrictive pattern and one, a mixed
pattern. Lung gammagram in two showed hypoperfusion and decreased
ventilatory capacity; one exhibited increased pulmonary vascularity.
Laboratory: There was positive C reactive protein in 13/27 patients; every
patient had a negative rheumatoid factor, but every child had positive
antinuclear antibodies; there were positive native anti DNA antibodies in
18/27; hemolytic complement was low in 19/27 and high globulins in 19/23;
high cryoglobulins were present in every case. The blood count was
consistent with anemia in 18/27; leucopenia in 10/27, lymphopenia in 13/27,
thrombocytopenia in 3/27 and elevated sedimentation rate in 22/23 patients.
Treatment. 18/27 patients were given prednisone; nine received
immunosuppressor drugs,
cyclophosphamide in 7/27 and azathioprine in 2/27 patients.
Conclusions. Pulmonary involvement
in children with SLE is more common (81.4%) in our country than has been
reported in the literature, 50 to 70 percent. Cough is the most common
respiratory symptom (72 percent) followed by dyspnea and polypnea (37.5
percent). The most common radiological finding was lupus pneumonitis (50
percent) followed by interstitial infiltrates (44 percent) and pleural
effusion (25 percent). The diagnosis should be timely since delayed
diagnosis and treatment have a direct bearing on the clinical course and
the prognosis of these children.