Abstract
Childhood-onset systemic lupus erythematosus (cSLE) is a rare disease with an incidence of 0.3-0.9 per 100,000 children-years and a prevalence of 3.3-8.8 per 100,000 children. Approximately 80% of patients with cSLE are female as in adult onset SLE. Etiology is unknown, but may be associated with genetic factors, non-organ specific humoral antibodies, impaired cell mediated immunity, environmental factors e.g. infections, stress etc. In recent decades, many researchers have focused on the role of viral infection in the etio-pathogenesis of systemic lupus erythematosus (SLE); cytomegalovirus (CMV) is considered to be most common virus reported, that may trigger SLE. We are reporting a male child with cSLE who suffered from varicella infection prior to the onset of severe SLE with lupus nephritis. Any patient with post viral exanthum, fever, photosensitive rash, arthralgia or arthritis should be investigated in detail to rule out underlying more serious autoimmune disease i.e. childhood lupus erythematosus.
Varicella zoster infection (chickenpox) is a very rarely reported trigger of cSLE.
Keywords- varicella zoster virus, childhood lupus erythematosus, infectious trigger, etiopathogensis.
References
- Kamphuis S, Silverman ED. Prevalence and burden of pediatric-onset systemic lupus erythematosus. Nat Rev Rheumatol. 2010; 6:538–546.
- Hiraki LT, Benseler SM, Tyrrell PN, et al. Clinical and laboratory characteristics and long-term outcome of pediatric systemic lupus erythematosus: a longitudinal study. J Pediatr. 2008; 152:550– 556.
- Pluchinotta FR, Schiavo B, Vittadello F, et al. Distinctive clinical features of pediatric systemic lupus erythematosus in three different age classes. Lupus. 2007; 16:550–555.
- D’Cruz D, Khamashta M, Hughes G. Systemic lupus erythematosus. Lancet. 2007;369:587Y596.
- Ramos-Casals M. Viruses and lupus: the viral hypothesis. Lupus. 2008;17:163Y165.
- Gross AJ, Hochberg D, Rand WM, Thorley-Lawson DA. EBV and systemic lupus erythematosus: a new perspective. J Immunol. 2005; 174:6599Y6607.
- Anders HJ, Vielhauer V, Eis V, Linde Y, Kretzler M, Perez de Lema G, Strutz F, Bauer S, Rutz M, Wagner H, Grone HJ, Schlondorff D. Activation of toll-like receptor-9 induces progression of renal disease in MRL-Fas(lpr) mice. FASEB J. 2004;18:534Y536.
- Barzilai O, Ram M, Shoenfeld Y. Viral infection can induce the production of autoantibodies. Curr Opin Rheumatol. 2007;19:636Y643.
- Stathopoulou EA, Routsias JG, Stea EA, Moutsopoulos HM, Tzioufas AG. Cross-reaction between antibodies to the major epitope of Ro60 kD autoantigen and a homologous peptide of Coxsackie virus 2B protein. Clin Exp Immunol. 2005;141:148Y154.
- Mok MY, Ip WK, Lau CS, Lo Y, Wong WH, Lau YL. Mannosebinding lectin and susceptibility to infection in Chinese patients with systemic lupus erythematosus. J Rheumatol. 2007;34:1270Y1276.
- JLrgensen TN, Gubbels MR, Kotzin BL. Links between type I interferons and the genetic basis of disease in mouse lupus. Autoimmunity. 2003;36:491Y502.
- Palucka AK, Blanck JP, Bennett L, Pascual V, Banchereau J. Crossregulation of TNF and IFN-alpha in autoimmune diseases. Proc Natl Acad Sci U S A. 2005;102:3372Y3377.
- Parks CG, Cooper GS, Hudson LL, Dooley MA, Treadwell EL, St Clair EW, Gilkeson GS, Pandey JP. Association of Epstein-Barr virus with systemic lupus erythematosus: effect modification by race, age, and cytotoxic T lymphocyte-associated antigen 4 genotype. Arthritis Rheum. 2005;52:1148Y1159.
- Ramos-Casals M, Cuadrado M.J, Alba P. et al. Acute viral infections in patients with systemic lupus erythematosus: description of 23 cases and review of the literature. Medicine (2008); 87(6):311-318.
- Esposito S, Bosis S, Semino M, Rigante D. Infections and systemic lupus erythematosus. Eur J Clin Microbiol Infect Dis 2014;33:1467-1475.
- Mina , Brunner. Update on differences between childhood-onset and adult-onset systemic lupus erythematosus. Arthritis Research & Therapy 2013, 15:218
- Francis L, Perl A. Infection in systemic lupus erythematosus: friend or foe? Int J Clin Rheumtol. 2010 February 1; 5(1): 59–74.
- Jung J Y, Suh C H. Infection in systemic lupus erythematosus, similarities, and differences with lupusflare. Korean J Intern Med 2017;32: 429-438.
- Hiraki LT , Benseler SM, Tyrrell PN, Hebert D, Harvey E, Silverman ED: Clinical and laboratory characteristics and long-term outcome of pediatric systemic lupus erythematosus: a longitudinal study. J Pediatr 2008, 152:550-556.
- Brunner H I, Gladman DD, Ibanez D, Urowitz MD, Silverman ED: Difference in disease features between childhood-onset and adult-onset systemic lupus erythematosus. Arthritis Rheum 2008, 58:556-562.
- Livingsto n B, Bonner A, Pope J: Diff erences in clinical manifestations between childhood-onset lupus and adult-onset lupus: a meta-analysis. Lupus 2011, 20:1345-1355
Corresponding Author
Dr Ghanshyam Verma
Dept. of Dermatology, Venereology and Leprosy,
Indira Gandhi Medical College, Shimla, HP, INDIA
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i2.129
