Week 19 Q&A

A 14-year-old adolescent girl presents with a history of low-grade fevers for 1 week, a rash on her face, painful swelling of her knee, and calf swelling.

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She reports chest pain when she takes a deep breath. On exam she has oral ulcers on the hard palate and butterfly-shaped redness on her cheeks and the bridge of her nose. Her knee is swollen, warm, and painful to move. The cardiac exam is normal. (See Figure 7–1.)

Figure 7-1 

Malar rash of systemic lupus erythematosus. Classic butterfly rash of systemic lupus erythematosus covering both cheeks and the bridge of the nose. The nasolabial folds are spared. (Reproduced with permission from Wolff K, Johnson RA, and Saavedra AP, eds. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 7th ed. New York, NY: McGraw-Hill Education; 2013, Fig. 14-33.)

What is the diagnosis? 

A. Acute rheumatic fever. 

B. Influenza. 

C. Systemic lupus erythematosus. 

D. Fibromyalgia. 

E. Endocarditis. 

The correct answer is “C.” Painless oral ulcers and her malar “butterfly” rash shout that this is systemic lupus erythematosus (SLE). SLE is a chronic autoimmune disease that affects multiple organ systems. It is more common in females and African Americans. It can occur in any age group but is uncommon in young children. The severity varies and intermittent flares are common.

Source: Peterson AR, Wood KE. Pediatrics Examination and Board Review; 2017.

Leah Carton

Associate Editor - Pediatrics, Dermatology, Geriatrics , McGraw Hill