全身性年青型風濕性關節炎轉化為紅斑性狼瘡－－病例報告

Conversion to Systemic Lupus Erythromatosus in a Child with Systemic Onset 15 Juvenile Rheumatoid Arthritis

在同一兒童身上出現兩種不同之結締組織疾病並不常見。吾人報告一16歲男孩因全身出現出血點及皮疹約二週求診。過去病史顯示病童於8歲即診斷為全身性年青型風濕性關節炎，經診斷治療後全身大小關節均嚴重變型。血清檢查顯示病童之抗體、抗雙鏈DNA抗體均呈陽性反應，且補體低下，皮膚組織切片亦顯示為狼瘡性皮疹，故符合系統性紅斑性狼瘡之診斷。對於長期關節病變之病童，須定期偵測紅斑性狼瘡之活性。

The sequential development of two connective tissue diseases (CTD) in the same patient has rarely been reported. We reported one such case in a 16-yearold boy who presented with severe, sympotomatic thrombocytopenia, and discoid rash after having systemic onset juvenile rheumatoid arthritis (S-JRA) for eight years. During the first 3 years of follow-up, the clinical manifestations were persistent systemic activities, with anemia, thrombocytosis, elevation of C-reactive protein, and arthritis with early involvement of hips and wrists. Deforming arthritis involving virtually all large and small joints of the extremities were noted. Serological findings revealed positive antinuclear antibody, postitive anti-double stranded DNA, and hypocomplementemia, thus fulfilling the criteria for diagnosis of SLE. In children with chronic arthropathy, the possibility of SLE conversion should be born in mind.