Scabies, Incomplete Lupus Erythematosus and Henoch-Schonlein Purpura: A Case Report

Background：Henoch-Schonlein purpura (HSP) is a common autoimmune vasculitis in childhood. Although the detailed etiology of HSP remains unknown, several triggers, especially for infectious agents, have been proved to be associated with HSP onset. Case presentation: In the present report, we describe an unusual patient who suffered from HSP and incomplete lupus erythematosus (ILE) on day 8 after scabies, mainly based on nonthrombocytopenic purpura, abdominal pain, medium proteinuria, positive antinuclear antibody (ANA) and skin scrapings. A course of pulse methylprednisolone (10mg/kg/day) was administered for 6 days, followed by oral prednisone (1mg/kg/day). On day 18, the purpuric rashes almost disappeared, whereas medium proteinuria still existed. In this circumstance, a renal biopsy was performed with the informed consent of the parents. According to the criteria proposed by the International Study of Kidney Disease in Children, this patient was classified as class IIIb. The immunofluorescence microscopy revealed granular deposits of IgA, IgM and C3 in the glomerular mesangium. His proteinuria gradually decreased after treatment of corticosteroids plus mycophenolate mofetil (20mg/kg/day). Conclusions: However, it should be noted that corticosteroids and immunosuppressors may increase the relapse risk of scabies, therefore this patient should be followed up carefully after discharging from our department.

Lupus: the new epidemic

Is systemic lupus erythematosus (SLE) is occurring more frequently now than in decades past? Despite improvements in the identification of patients with SLE, the development of new classification criteria, and the recognition of several biomarkers used alone or in combination, the diagnosis of SLE is still a challenge for clinicians, in particular early in the course of the disease, which makes the recognition of secular trends difficult to ascertain. Lacking a uniform definition of preclinical lupus or incomplete lupus, it is difficult to predict accurately which patients would go on to develop SLE. We will briefly review the classification criteria, early or preclinical SLE, the epidemiology of SLE, antinuclear antibodies-negative SLE, and biomarkers of the disease.