Date

P
Therapy

12/0
1/20
15

Fever (-),
cough (-),
vomiting
(-)

Sens : Alert
T : 36,8 C
BW : 36kg

SLE
( month to
IV)

-Inj.

Consult to
Methylpred Gastro
Hepatologi
nisolone
1000 mg in

BH : 155cm

100cc NaCl

Head: both sides of the

cheeks : malar rash (+),
eye reflect +/+, isocor,
pale
conj.
Palpebra
inferior+/+,
Ear/Nose/Mouth: normal

0.9% finish

Neck: JVP R+2 cm H2O

mix with

Thorax : Symmetris
fusiformis, retraction (-),
HR : 92x/I, reguler,
murmur (-) RR : 24x/i,
reguler, ronchi -/-

Mesna

Abdomen
:
soepel,
normal peristaltic,
Hepar: Not Palpeble
Lien: Not Palpeble
Extremities : pulse 92x/i,
reguler,
adequate
pressure and volume,
warm, CRT <3, pretibial
edema (-)
Lab results : -

Diagnostic

in 1 hour.
-Inj. CPA
840mg
(20/m2)

500mg
-Methyl
prednisolo
ne tab 3-33
-Normal
diet
1800kcal
with 72mg
protein

13/0
1/20
16
14/1
2/20
16

fever (-), Sens : Alert

cough
T : 37,1 C
(-),
vomiting BW : 36kg
(-)
BH : 155cm

SLE ( month to
IV)

-Inj.

Consult to
Methylpred Gastro
Hepatologi
nisolone
1000 mg in
100cc NaCl

Head: both sides of the

cheeks : malar rash (+),
eye reflect +/+, isocor,
pale
conj.
Palpebra
inferior-/-,
Ear/Nose/Mouth: normal

0.9% finish

Neck: JVP R+2 cm H2O

mix with

Thorax : Symmetris
fusiformis, retraction (-),
HR : 100x/I, reguler,
murmur (-) RR : 24x/i,
reguler, ronchi -/-

Mesna

Abdomen
:
soepel,
normal peristaltic,
Hepar: NOT palpeble
BAC Lien:
palpeble

NOT

Extremities
:
pulse
100x/i, reguler, adequate
pressure and volume,
warm, CRT <3, pretibial
edema (-)
Lab Test : -

in 1 hour.
-Inj. CPA
840mg
(20/m2)

500mg
-Methyl
prednisolo
ne tab 3-33
-Normal
diet
1800kcal
with 72mg
protein

15012016

fever (-), Sens : Alert

cough
T : 36,9 C
(-),
vomiting BW : 36kg
(-)
BH : 155cm

SLE (month
to IV)

-Inj.
Methylpred
nisolone
1000 mg in
100cc NaCl

Head: both sides of the

cheeks : malar rash (+),
eye reflect +/+, isocor,
pale
conj.
Palpebra
inferior-/-,
Ear/Nose/Mouth: normal

0.9% finish

Neck: JVP R+2 cm H2O

mix with

Thorax : Symmetris
fusiformis, retraction (-),
HR : 100x/I, reguler,
murmur (-) RR : 24x/i,
reguler, ronchi -/-

Mesna

Abdomen
:
soepel,
normal peristaltic, Hepar:
palpeble 2cm BAC Lien:
palpeble SIII
Extremities
:
pulse
100x/i, reguler, adequate
pressure and volume,
warm, CRT <3, pretibial
edema (-)
Lab test :
Hepar:

AST/SGOT: 88 U/L
ALT/SGPT: 86 U/L

in 1 hour.
-Inj. CPA
840mg
(20/m2)

500mg
-Methyl
prednisolo
ne tab 3-33
-Normal
diet
1800kcal
with 72mg
protein
- paresol
cream

DISCUSSION

THEORY

CASE

EPYDEMIOLOGY :

A girl

Pediatric SLE (pSLE) represents approximately

15-20 % of all SLE patients. It is more common in
females than in males, with a female to male ratio
varying from 2.3:1 to 9:1, depending on the study.
The incidence of the disease varies according to
different ethnic groups. SLE is more common in
African-American females.

14 years old
An asian

ETIOLOGY :
1.
2.
3.
4.
5.
6.

Idiopatic
Genetic factor
Epigenetic effect
Hormonal factor
Drug. Induced Lupus Erythematous
Neonatal Lupus Erythematous

Idiopatic

CLASIFICATION ACR :
1. Malar rash
2. Discoid rash
3. Photosensitivity
4. Oral ulcers
5. Arthritis
6. Serositis
7. Glomerulonephritis
8. Neurologic disorder: Seizures and/or
psychosis
9. Hematologic disorder:

1. malar rash
2. Photosensitivity
3. Arthritis,
4. abnormality antinuclear
antibodies

Immune-mediated hemolytic
anemia, leukopenia,
lymphopenia,Thrombocytopenia
10. Antinuclear antibodies (ANA)
11. Immunologic disorder:
anti-DNA antibody, anti-Sm
antibody, or antiphospholipid
antibodies

LAB DIAGNOSTIC:

Cytopenias (anemia, thrombocytopenia,

leukopenia)

Elevated ESR, CRP, Immunoglobulins

Hypoalbuminemia

Proteinuria; RBCs, casts in urine

Decreased creatinine clearance

Low complement levels (C3/ C4)

Autoantibodies (ANA, APL, Coombs, antiplatelet Ab, rheumotoid factor, etc.)

(Immune complexes

Elevated ESR
AST/ALT : 145/126
Decreased cratinine
ANA test +

TREATMENT:

Corticosteroids

Cyclophosphamide

Methotrexate

Corticosteroid:
Methylprednisolone
Cyclophosphamide

Mycophenolate mofetil

Azathioprine

Hydroxychloroquine

Rituximab