Immunological Disorders and Immunotherapy
Open Access

Abstract

Hypertensive Emergency in Adolescent with Systemic Lupus Erythematosus at Onset: A Case Report

Maria Elena Cucuzza, Maria Teresa Garozzo, Daniele Attardo, Stefania Tomarchio, Chiara Franzonello, Giovanni Conti, Salvatore Leonardi and Patrizia Barone

The severity of Systemic lupus erythematosus (SLE) at onset represents the most important biomarker of disease outcome and of treatment response in paediatric patients. Kidney disease, chronic systemic inflammation and steroid toxicity could cause hypertension development. Thirteen year old child presenting with serositis, hemolytic anemia, leucopenia, thrombocytopenia and lupus nephritis was treated according to Euro Lupus Protocol. A progressive deterioration of kidney function was observed during the treatment with increased blood pressure for about a month after the beginning of the treatment. The antihypertensive therapy established by the Italian society of pediatrics (SIP) and consisting of diuretic therapy (Furosemide 1 mg/Kg/die) and angiotensin-converting-enzyme (ACE) inhibitor therapy (Enalapril 0.06 mg/Kg/die) was initiated. Persisting hypertensive peaks, calcium antagonist therapy (Amlodipina 5 mg/die) and α2 adrenergic therapy (Clonidina one plaster/2.5 mg/week) were added. After gaining control of the hypertensive peaks, the antihypertensive treatment was gradually reduced. There are no treatment protocols for the management of hypertension associated with SLE in children in the literature. In our case the early treatment with the SIP protocol determined reduction in urinary protein levels and avoided acute organ damage related to hypertension peaks.