A case of S.L.E. preceded by a long-standing thrombocytopenic purpura.

Abstract

The cases of systemic lupus erythematosus with presenting symptoms of thrombocytopenic purpura have been rare in Japan.
A 17-year-old female case of systemic lupus erythematosus (S.L.E.) was presented, in which the thrombocytopenic purpura had been the only symptom for three years since the onset. She had been treated with prednisolone, but there was no remarkable improvement. Hemorrhagic diathesis subsided following splenectomy, whereas no significant elevation in platelet count was observed. The histological examination of the spleen disclosed the presence of marked onion skin lesion.
About ten months after splenectomy, clinical manifestations of S.L.E. such as skin rashes, arthritis, carditis, nephritis ans paralytic ileus, developed. These manifestations were successfully treated with salicylates, chloroquine and large dosis of prednisolone. The patient has been followed in the outpatient clinic and is now free from symptoms with minimal dosis of prednisolone.
Differential diagnosis and relationship between idiopathic thrombocytopenic purpura and thrombocytopenic purpura of S.L.E. was discussed.