04 Dec 2023
30 Nov 2023
Approximately, 15% to 20% of systemic lupus erythematosus (SLE) patients are children especially from the Asian and African ethnicities. Co-existence of SLE and COVID-19 leads to complex management. We report a case involving an eleven-year-old boy who initially presented with vesico-bullous lesions of his lower lip followed by fever and malar rash. At this stage, viral infection was suspected. Simultaneously the boy was also tested positive for COVID-19. Following that, the disease progressed and the boy was transferred to the Paediatric Intensive Care Unit. A diagnosis of SLE was finally made based on the 2019 EULAR/ACR classification which showed a score of 26. He showed cardiac and pulmonary signs before his kidney deteriorated. A cytokine storm was suspected and he had to be supported with inotropes. The boy finally succumbed to his illness after all efforts failed to resuscitate him. We conclude that in this case, the SLE was complicated by concurrent COVID-19 and it progressed to cytokine storm and hemophagocytic lymphohistiocytosis or macrophage activation syndrome that resulted in fatal outcome.