2025 Volume 75 Issue 3 Pages 277-283
Multisystem inflammatory syndrome in children (MIS-C) can occur after coronavirus disease 2019 (COVID-19) infection. Moreover, although various viral infections have been associated with the onset of systemic lupus erythematosus (SLE）, there have been reports of its development following COVID-19 infection. Here we report the case of a 10-year-old girl diagnosed with SLE after COVID-19 who presented with an MIS-C-like course of persistent fever, bulbar conjunctival hyperemia, strawberry tongue, erythema of the anterior chest, edema of the lower extremities, lymphocytopenia, and coagulopathy. She was initially diagnosed with MIS-C and treated with oral aspirin and high-dose intravenous immunoglobulin; however, her condition did not improve. She exhibited malar rash, developed hypocomplementemia, and tested positive for anti-double-stranded DNA and anti-single-stranded DNA antibodies. The patient was subsequently diagnosed with SLE. After the initiation of oral prednisolone therapy, her symptoms improved quickly. Including the present case, 11 pediatric cases of SLE diagnosed post-COVID-19 have been reported to date. Among them, MIS-C was suspected during the clinical course in four cases. These cases demonstrate that it is crucial to distinguish between MIS-C and SLE. In cases in which fever and lymphocytopenia persist after COVID-19, SLE should be considered a differential diagnosis in addition to MIS-C.
