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Rouag H, Zayani S, Akid A, Ghedira T, Sfar E, Hadj Salem R, Chouchane C, Thabet F, Chouchane S. 85 Systemic lupus erythematosus in Tunisian children: a case series. Rheumatology (Oxford) 2022. [PMCID: PMC9538749 DOI: 10.1093/rheumatology/keac496.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Childhood–onset systemic lupus erythematosus (c-SLE) is the prototype of a multisystem, inflammatory, heterogeneous autoimmune condition, characterized by simultaneous or sequential organ involvement. Compared with the adult-onset form, c-SLE have a worse prognosis. Objectives To review the epidemiological, and bio-clinical, characteristics of a c-SLE case series. Methods The files of patients diagnosed as c-SLE in the pediatrics department of Monastir, Tunisia from January 2004 to March 2022 were reviewed. Mean and standard-deviation were used to express normally-distributed variables, as verified by the Kolmogorov-Smirnov statistical test. Results Fourteen patients were collected. Female to male ratio was 6:1. Mean ages at lupus onset and diagnosis were 9.9 ± 1.4 years, [5–13.8 years] and 10.75 ± 2.3 years [6–14 years], respectively. Only two children had a family history of autoimmune disease. The initial admission was motivated primarily by skin and musculoskeletal manifestations, in 64.3% and 51.7% of cases, respectively. General signs (fever, asthenia) were observed in 35.7% of cases, hematological and gastrointestinal manifestations in 28.6% of cases each. In 3 cases, upper gastric endoscopy was performed prior to admission, in view of abdominal pain and vomiting. The physical examination noted various abnormalities. Malar rash (50%) and discoid lupus (28.6%) were the most frequent cutaneous manifestations, while skin biopsy was performed in three cases, all in keeping with lupus. The musculoskeletal manifestations were arthralgia (71.4%), arthritis and myositis (14.3%). Hematological manifestations included thrombocytopenia and leukopenia in 4 cases, as well as 3 cases of auto-immune hemolytic anaemia and splenomegaly. Renal manifestations were proteinuria in 7, haematuria in 6, and hypertension in 2 (with renal failure in one of the patients). The renal biopsy that was performed in one subject showed a class 2 lupus nephritis. Pleural effusion was observed in 3, pneumonia in 3, pericarditis in 2, myo-pericarditis in 1 and central nervous system (CNS) lupus in 1. Relevant results of the laboratory workup are illustrated in the following table: The formal diagnosis of SLE was established according to the ACR-1997 criteria in 7 cases (50%), the SLICC-2012 in 4 cases (28.6%) and EULAR/ACR-2019 in 3 cases (21.4%). The c-SLE diagnosis was associated with coeliac disease and Hashimoto thyroiditis in two of the subjects respectively. The therapeutic management was based on corticosteroids in 11 cases, hydroxychloroquine in 3, while cyclophosphamides and immunoglobulin were used for two subjects respectively. The outcomes were heterogeneous. Among 11 patients with sufficient follow-up, 6 cases of remission and 2 cases of relapse were noted. Major adverse events were not infrequent: one case each of cardiac tamponade, macrophage activation syndrome and severe CNS lupus were observed, all fatal. Conclusion Childhood–onset systemic lupus is a challenging disease, both to diagnose and to treat. The development of new criteria of higher specificity and sensitivity has greatly helped identify the incomplete types of lupus and allow for early-stage diagnosis, therefore preventing the serious complications of the disease.
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Affiliation(s)
- H Rouag
- Department of Pediatrics, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - S Zayani
- Department of Pediatrics, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - A Akid
- Department of Pediatrics, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - T Ghedira
- Department of Pediatrics, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - E Sfar
- Department of Pediatrics, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - R Hadj Salem
- Department of Pediatrics, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - C Chouchane
- Department of Pediatrics, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - F Thabet
- Department of Pediatrics, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - S Chouchane
- Department of Pediatrics, Fattouma Bourguiba Hospital, Monastir, Tunisia
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Rouag H, Zayani S, Akid A, Ghedira T, Sfar E, Hadj salem R, Chouchane C, Thabet F, Chouchane S. 47 Systemic lupus erythematosus in Tunisian children: a case series. Rheumatology (Oxford) 2022. [PMCID: PMC9539001 DOI: 10.1093/rheumatology/keac496.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Childhood–onset systemic lupus erythematosus (c-SLE) is the prototype of a multisystemic, inflammatory, heterogeneous autoimmune condition, characterized by simultaneous or sequential organ involvement. Compared with the adult onset form, c-SLE is thought to have a worse prognosis. Objectives To review the epidemiological, and bio-clinical, characteristics of a c-SLE case series. Methods The files of patients diagnosed as c-SLE in the pediatrics department of Monastir, Tunisia from January 2004 to March 2022 were reviewed. Mean and standard-deviations were used to express normally-distributed variables, as verified by the Kolmogorov-Smirnov statistical test. Results Fourteen patients were collected. Female to male ratio was 6:1. Mean ages at lupus onset and diagnosis were 9.9 ± 1.4 years, [5–13.8 years] and 10.75 ± 2.3 years [6–14 years], respectively. Only two children had a family history of autoimmune disease. The initial admission was motivated primarily by skin and musculoskeletal manifestations, in 64.3% and 51.7% of cases, respectively. General signs (fever, asthenia) were observed in 35.7% of cases, hematological and gastrointestinal manifestations in 28.6% of cases each. In 3 cases, upper gastric endoscopy was performed prior to admission, in view of abdominal pain and vomiting. The physical examination noted various anomalies. Malar rash (50%) and discoid lupus (28.6%) were the most frequent cutaneous manifestations, while skin biopsy was performed in three cases, all favorable for lupus. The musculoskeletal manifestations comprised arthralgia (71.4%), arthritis and myositis (14.3% each). Hematological manifestations included thrombocytopenia and leukopenia in 4 cases each, as well as 3 cases of auto-immune hemolytic anaemia and splenomegaly. Renal manifestations were dominated by proteinuria in 7 cases, followed by hematuria in 6 cases, and 2 cases of hypertension (associated with renal failure in one case). The renal biopsy was performed in one case showed a stage-2 lupus nephritis. Pleural effusion was observed in 3 cases, 3 cases of pneumonia, 2 cases of pericarditis, one case of myo-pericarditis and one case of central nervous system (CNS) lupus. Relevant results of the laboratory workup are illustrated in the following table: The formal diagnosis of SLE was established according to the ACR-1997 criteria in 7 cases (50%), the SLICC-2012 in 4 cases (28.6%) and EULAR/ACR-2019 in 3 cases (21.4%). The c-SLE diagnosis was associated with coeliac disease and Hashimoto thyroiditis in one case each. The therapeutic management was based on corticosteroids in 11 cases, followed by hydroxychloroquine in 3 cases, while cyclophosphamides and immunoglobulin were used for one case each. The outcomes were heterogeneous. Among 11 patients with sufficient follow-up, 6 cases of remission and 2 cases of relapse were noted. Major adverse events were not infrequent: one case each of cardiac tamponade, macrophage activation syndrome and severe CNS lupus were observed, all fatal. Conclusion Childhood–onset systemic lupus is a challenging disease, both to diagnose and to treat. The development of new criteria of higher specificity and sensitivity has greatly helped identify the incomplete types of lupus and allow for early stage diagnosis, and therefore prevent the serious complications of the disease.
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Affiliation(s)
- H Rouag
- Department of Pediatrics Fattouma Bourguiba Hospital Monastir, Tunisia
| | - S Zayani
- Department of Pediatrics Fattouma Bourguiba Hospital Monastir, Tunisia
| | - A Akid
- Department of Pediatrics Fattouma Bourguiba Hospital Monastir, Tunisia
| | - T Ghedira
- Department of Pediatrics Fattouma Bourguiba Hospital Monastir, Tunisia
| | - E Sfar
- Department of Pediatrics Fattouma Bourguiba Hospital Monastir, Tunisia
| | - R Hadj salem
- Department of Pediatrics Fattouma Bourguiba Hospital Monastir, Tunisia
| | - C Chouchane
- Department of Pediatrics Fattouma Bourguiba Hospital Monastir, Tunisia
| | - F Thabet
- Department of Pediatrics Fattouma Bourguiba Hospital Monastir, Tunisia
| | - S Chouchane
- Department of Pediatrics Fattouma Bourguiba Hospital Monastir, Tunisia
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Dorval G, Gribouval O, Martinez-Barquero V, Machuca E, Tête MJ, Baudouin V, Benoit S, Chabchoub I, Champion G, Chauveau D, Chehade H, Chouchane C, Cloarec S, Cochat P, Dahan K, Dantal J, Delmas Y, Deschênes G, Dolhem P, Durand D, Ekinci Z, El Karoui K, Fischbach M, Grunfeld JP, Guigonis V, Hachicha M, Hogan J, Hourmant M, Hummel A, Kamar N, Krummel T, Lacombe D, Llanas B, Mesnard L, Mohsin N, Niaudet P, Nivet H, Parvex P, Pietrement C, de Pontual L, Noble CP, Ribes D, Ronco P, Rondeau E, Sallee M, Tsimaratos M, Ulinski T, Salomon R, Antignac C, Boyer O. Clinical and genetic heterogeneity in familial steroid-sensitive nephrotic syndrome. Pediatr Nephrol 2018; 33:473-483. [PMID: 29058154 DOI: 10.1007/s00467-017-3819-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Familial steroid-sensitive nephrotic syndrome (SSNS) is a rare condition. The disease pathophysiology remains elusive. However, bi-allelic mutations in the EMP2 gene were identified, and specific variations in HLA-DQA1 were linked to a high risk of developing the disease. METHODS Clinical data were analyzed in 59 SSNS families. EMP2 gene was sequenced in families with a potential autosomal recessive (AR) inheritance. Exome sequencing was performed in a subset of 13 families with potential AR inheritance. Two variations in HLA-DQA1 were genotyped in the whole cohort. RESULTS Transmission was compatible with an AR (n = 33) or autosomal dominant (AD, n = 26) inheritance, assuming that familial SSNS is a monogenic trait. Clinical features did not differ between AR and AD groups. All patients, including primary (n = 7) and secondary steroid resistant nephrotic syndrone (SRNS), (n = 13) were sensitive to additional immunosuppressive therapy. Both HLA-DQA1 variations were found to be highly linked to the disease (OR = 4.34 and OR = 4.89; p < 0.001). Exome sequencing did not reveal any pathogenic mutation, neither did EMP2 sequencing. CONCLUSIONS Taken together, these results highlight the clinical and genetic heterogeneity in familial SSNS. Clinical findings sustain an immune origin in all patients, whatever the initial steroid-sensitivity. The absence of a variant shared by two families and the HLA-DQA1 variation enrichments suggest a complex mode of inheritance.
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Affiliation(s)
- Guillaume Dorval
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France. .,Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France.
| | - Olivier Gribouval
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France
| | - Vanesa Martinez-Barquero
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France
| | - Eduardo Machuca
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France
| | - Marie-Josèphe Tête
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France
| | - Véronique Baudouin
- Department of Pediatric Nephrology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris, France
| | - Stéphane Benoit
- Department of Nephrology, University Hospital of Tours, Tours, France
| | - Imen Chabchoub
- Department of Pediatrics, Sfax University, Sfax, Tunisia
| | - Gérard Champion
- Department of Pediatrics, University Hospital of Angers, Angers, France
| | - Dominique Chauveau
- Department of Nephrology and Organ Transplantation, University Hospital Rangueil, Toulouse, France
| | - Hassib Chehade
- Department of Pediatrics, Division of Pediatric Nephrology, Lausanne University Hospital, Lausanne, Switzerland
| | - Chokri Chouchane
- Department of Pediatrics, Monastir University, Monastir, Tunisia
| | - Sylvie Cloarec
- Department of Nephrology, University Hospital of Tours, Tours, France
| | - Pierre Cochat
- Department of Pediatric Nephrology, Claude-Bernard Lyon 1 University, Bron, France
| | - Karin Dahan
- Department of Human Genetics, Institute of Pathology and Genetics, Gosselies, Belgium
| | - Jacques Dantal
- Nephrology and Immunology Department, University Hospital of Nantes, Nantes, France
| | - Yahsou Delmas
- Department of Nephrology, University Hospital of Bordeaux, Bordeaux, France
| | - Georges Deschênes
- Department of Pediatric Nephrology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris, France
| | - Phillippe Dolhem
- Department of Pediatrics, Saint-Quentin Hospital, Saint-Quentin, France
| | - Dominique Durand
- Department of Nephrology and Organ Transplantation, University Hospital Rangueil, Toulouse, France
| | | | - Khalil El Karoui
- Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France
| | - Michel Fischbach
- Nephrology Dialysis Transplantation Children's Unit, University Hospital Hautepierre, Strasbourg, France
| | - Jean-Pierre Grunfeld
- Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France
| | - Vincent Guigonis
- Department of Pediatrics, University Hospital of Limoges, Limoges, France
| | | | - Julien Hogan
- Department of Pediatric Nephrology, Assistance Publique-Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France
| | - Maryvonne Hourmant
- Nephrology and Immunology Department, University Hospital of Nantes, Nantes, France
| | - Aurélie Hummel
- Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, University Hospital Rangueil, Toulouse, France
| | - Thierry Krummel
- Department of Nephrology, University Hospital Hautepierre, Strasbourg, France
| | - Didier Lacombe
- Department of Genetics, University Hospital of Bordeaux, Bordeaux, France
| | - Brigitte Llanas
- Department of Pediatrics, University Hospital of Bordeaux, Bordeaux, France
| | - Laurent Mesnard
- Department of Nephrology and Dialysis, Assistance Publique-Hôpitaux de Paris, Tenon Hospital, Paris, France.,Sorbonne University, UPMC University Paris 06, Paris, France.,INSERM, UMR_S 1155, 75020, Paris, France
| | - Nabil Mohsin
- College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Patrick Niaudet
- Department of Pediatric Nephrology, Centre de référence du syndrome néphrotique idiopathique de l'enfant et l'adulte, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France.,Centre de Référence Syndrome Néphrotique Idiopathique de l'enfant et de l'adulte, Paris, France
| | - Hubert Nivet
- Department of Nephrology, University Hospital of Tours, Tours, France
| | - Paloma Parvex
- Department of Pediatrics, Division of Pediatric Nephrology, Geneva University Hospital, Geneva, Switzerland
| | - Christine Pietrement
- Departement of Pediatrics, Nephrology Unit, University Hospital of Reims, Reims, France.,Faculty of Medicine, Laboratory of Biochemistry and Molecular Biology, UMR, CNRS/URCA n°7369, University of Champagne-Ardenne, Reims, France
| | - Loic de Pontual
- Department of Pediatrics, Assistance Publique-Hôpitaux de Paris, Jean Verdier Hospital, Bondy, France
| | - Claire Pouteil Noble
- Department of Nephrology and Transplantation, University Hospital of Lyon, Lyon, France
| | - David Ribes
- Department of Nephrology and Organ Transplantation, University Hospital Rangueil, Toulouse, France
| | - Pierre Ronco
- Department of Nephrology and Dialysis, Assistance Publique-Hôpitaux de Paris, Tenon Hospital, Paris, France.,Sorbonne University, UPMC University Paris 06, Paris, France.,INSERM, UMR_S 1155, 75020, Paris, France
| | - Eric Rondeau
- Department of Nephrology and Dialysis, Assistance Publique-Hôpitaux de Paris, Tenon Hospital, Paris, France
| | - Marion Sallee
- Department of Nephrology and Kidney Transplantation, The Conception Hospital, Marseille, France
| | - Michel Tsimaratos
- Department of Multidisciplinary Pediatrics Timone, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Tim Ulinski
- Department of Pediatric Nephrology, Assistance Publique-Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France
| | - Rémi Salomon
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France.,Department of Pediatric Nephrology, Centre de référence du syndrome néphrotique idiopathique de l'enfant et l'adulte, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France.,Centre de Référence Syndrome Néphrotique Idiopathique de l'enfant et de l'adulte, Paris, France
| | - Corinne Antignac
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France.,Centre de Référence Syndrome Néphrotique Idiopathique de l'enfant et de l'adulte, Paris, France.,Department of Genetics, Assistance Publique-Hôpitaux de Paris, Necker-Enfants malades Hospital, Paris, France
| | - Olivia Boyer
- INSERM UMR1163, Laboratory of Hereditary Kidney Diseases, Imagine Institute, 24 Boulevard du Montparnasse, 75015, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France.,Department of Pediatric Nephrology, Centre de référence du syndrome néphrotique idiopathique de l'enfant et l'adulte, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France.,Centre de Référence Syndrome Néphrotique Idiopathique de l'enfant et de l'adulte, Paris, France
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