Juvenile-onset systemic lupus erythematosus with multisystem involvement complicated by posterior reversible encephalopathy syndrome (PRES)

A previously healthy girl in her middle childhood of African origin presented with a 2-week history of fever and sore throat. Initial tests showed pancytopenia and proteinuria while the septic screen was negative except for the presence of parvovirus B19 infection. When her symptoms persisted, the possibility of an underlying connective tissue disorder such as systemic lupus erythematosus (SLE) was explored and confirmed. Despite the initiation of glucocorticoids, she went on to develop renal and neuropsychiatric involvement which only responded to high-dose immunosuppression including plasma exchange. This case demonstrates the aggressiveness and rapidity of organ involvement in juvenile-onset SLE and the need for timely appropriate immunosuppression and treatment escalation.