Analysis Of Clinical Characteristics Of Pediatric Systemic Lupus Erythematosus Complicated With Central Nervous System Infections:Seven Cases Reports

Objective:To investigate the clinical characteristics of pediatric systemic lupus erythematosus complicated with central nervous system infection,so as to provide basis for early diagnosis,early treatment and improve prognosis.Methods:The clinical data of 7 children with pediatric systemic lupus erythematosus complicated with central nervous system infection admitted to the Pediatrics department of China-Japan Union Hospital of Jilin University from 2015.01 to 2020.06 with clear diagnosis and complete clinical data were collected,and their clinical characteristics were retrospectively analyzed.Results:Patients ranged in age from 11 to 16 years,with a mean age of 13.4years.Among them,there were 1 male child and 6 female children.The time from the onset of systemic lupus erythematosus to the diagnosis of central nervous system infection was 3 months to 2 years,with an average of 9.1 months.Among the 7 patients,1 had fungal infection,2had tuberculosis infection and 4 had non-tuberculosis infection.There were 1 brain abscess and 6 cases of meningitis.Headache and fever were the common clinical manifestations in the first symptoms,including vomiting and hemiplegia in 1 case,visual impairment in 1 case,convulsion and disturbance of consciousness in 1 case.Among them,6cases were treated with oral glucocorticoid maintenance therapy before onset of CNS infection,and the average treatment time was 9.3 months.3patients had received glucocorticoid shock therapy at a dose of 15mg/kg for 3 days.6 cases were treated with immunosuppressive agents including cyclophosphamide,azathioprine,tripterygium glycosides and hydroxychloroquine.All patients were given standard anti-infective therapy according to the etiological results,including meropenem,fluconazole,penicillin and vancomycin.3 cases were cured or improved,3 cases were not significantly improved,and 1 case died.Conclusion:The clinical symptoms of children with systemic lupus erythematosus complicated with nervous system infection are not typical,most of them are meningitis,and there may be fever,headache,convulsion and disturbance of consciousness.Lumbar puncture and cerebrospinal fluid(CSF)examination and head imaging examination should be performed as soon as possible to facilitate early diagnosis,standardized treatment and improve the prognosis of children.