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Key Clinical Message: Systemic Lupus Erythematosus (SLE) can have an insidious onset and a fatal prognosis in children. Patients presenting without typical signs of SLE should undergo further evaluation if they are not responding to the initial diagnosis and treatment. This is especially true for patients with rapidly progressing symptoms and deterioration in spite of treatment. Pediatric Systemic Lupus Erythematosus is a chronic autoimmune disorder with various organ involvement pulmonary involvement in the course of this disorder is a rare yet potentially life‐threatening complication. In this case report we highlight the findings of a 16‐year‐old girl acutely and initially presenting with cough and fever, eventually complicating to diffuse alveolar hemorrhage and gradual loss of consciousness. Although the patient was started on immunosuppressive treatment after the diagnosis of lupus, based on renal and hematological impairment, was made and initially responded, she eventually deteriorated. [ABSTRACT FROM AUTHOR]

Background: A common type of chronic arthritis in children and adolescents is juvenile idiopathic arthritis (JIA). According to the International League of Associations for Rheumatology (ILAR) classification, JIA diagnostic criteria include age under 16 years and disease duration of six-weeks. Based on the number of involved joints in the first sixmonths of disease onset, JIA is categorized into oligoarticular or polyarticular subtypes. Age is a characteristic factor in the diagnosis of disease subsets; it is worth mentioning that cases younger than six months of age are seldom found in any of the subtypes. Case report: In this report, we present a rare case of JIA in an infant, presenting at 20 days of age. Effusion of the right hip joint was one of the primary manifestations of the disease. During hospitalization, she went through sepsis workup and a four-week antibiotic therapy for management of lower limb pseudoparalysis. In spite of antibiotic therapy, she developed effusion of a second joint. According to the course and duration of symptoms and ILAR classification for JIA, oligoarticular JIA was diagnosed and treated. Conclusion: In this case, infectious diseases, such as tuberculosis and brucellosis, and malignancies were ruled out as a cause of inflammation through bone marrow aspiration, culture, and tests; ultrasound and magnetic resonance imaging showed no lytic and sclerotic lesions or a fracture. Our experience showed a rare case of JIA and suggested that JIA must be considered in children with joint inflammation at any age. [ABSTRACT FROM AUTHOR]

Background: Juvenile Rheumatoid Arthritis (JRA) is the most common chronic pediatric rheumatologic disease. There is a wide range of variation in disease subgroup distribution and evolution according to different populations, environments and genetic predisposition. This study was designed to evaluate epidemiologic characteristics of JRA in Iran. Methods: A cross-sectional studies was performed on children suffering from JRA according to American College of Rheumatology during 10 year (2002-2011). Patients' data was recorded in hospital questionnaires; Patients' age at the first presentation and time of diagnosis, sex, ethnicity, early clinical and constitutional presentations, joint involvement pattern and presence of associated diseases were evaluated. Results: In this study, 171 children (91 boys and 80 girls) were enrolled. The mean age of patients was 5.2±3.5 years at the time of presentation and 5.7±3.6 years when the diagnosis was confirmed. The most common type of disease was polyarticular arthritis (41.9%). The prevalence of pauciarticular and systemic onset subtype were 31.6% and 19.3%, respectively. According to ethnicity, the most common incidence was seen in Fars and Turk populations respectively. The most common constitutional presentation was fever. Fever and morning stiffness was significantly higher in polyarticular patients. Extra articular manifestation was seen in 40.4% patients. Among extra-articular manifestations, skin involvement was seen more than others. There was no correlation between sex and type of chronic arthritis. Uveitis was detected in 5.8% of our cases. The mean age was significantly higher in polyarticular group (6.04 year) in comparison to pauciarticular and systemic group (4.4 year in both groups) (P=0.005). There was no correlation between sex and type of chronic arthritis. Conclusion: The prevalence of JRA subgroups was different in Iran comparing with western countries and polyarticular disease was the most common subgroup in this study. Uveitis was less common in this study in comparison to studies in other countries. There is no sex predilection in each subgroup of JRA. [ABSTRACT FROM AUTHOR]