Drug-induced systemic lupus erythematosus (SLE)-like syndromes in children are most commonly associated with the administration of ethosuximide, diphenylhydantoin, and trimethadione. Five children receiving ethosuximide who presented with syndromes suggestive of SLE were studied. Each and fever, malar rash, arthritis, and lymphadenopathy. Two children had pleural effusions and another developed myocarditis and pericarditis. Three patients had anti-DNA antibodies associated with low serum C3. In four of five children symptoms disappeared with the discontinuation of ethosuximide; two of these continue to have antinuclear antibodies (ANA). One child continues to have active SLE with nephritis. A group of 101 children from a seizure clinic were tested for the presence of ANA. ANA were found in 14 of 70 children receiving ethosuximide and/or diphenylhydantoin; 2 of 14 had anti-DNA antibodies. Serum ANA titers in the drug-induced SLE group did not differ significantly from those of the asymptomatic seizure patients. ANA were also present in 5 of 23 children receiving phenobarbital only. The induction of ANA by phenobarbital is a possible hypothesis. Quantitative immunoglobulins and C3 were not significantly altered in the asymptomatic children with ANA. Follow-up studies at ten months showed no asymptomatic child with ANA to have developed clinical with ANA to have developed clinical evidence of SLE. This study suggests that asymptomatic children who develop ANA should have careful observation, but need not have their anticonvulsants discontinued.

译文

儿童药物诱导的系统性红斑狼疮 (SLE) 样综合征最常见的是使用乙硫胺,二苯乙内酰脲和三美甲二酮。研究了五名接受ethosuximide的儿童,他们出现了提示SLE的综合征。每个发热,斑疹,关节炎和淋巴结肿大。两个孩子有胸腔积液,另一个则发展为心肌炎和心包炎。三名患者的抗DNA抗体与低血清c3相关。在五名儿童中,有四名症状随着ethosuximide的停用而消失; 其中两个继续具有抗核抗体 (ANA)。一名儿童继续患有活动性系统性红斑狼疮并肾炎。对来自癫痫发作诊所的101名儿童进行了ANA的测试。在接受乙硫胺和/或二苯乙内酰脲的70名儿童中,有14名发现了ANA; 14个中有2个具有抗DNA抗体。药物诱导的SLE组的血清ANA滴度与无症状癫痫患者的血清ANA滴度无显着差异。仅接受苯巴比妥治疗的23名儿童中有5名也存在ANA。苯巴比妥诱导ANA是一个可能的假设。在无症状的ANA儿童中,定量免疫球蛋白和C3没有显着改变。10个月的随访研究显示,没有无症状的ANA患儿发展为临床的ANA并发展为SLE的临床证据。这项研究表明,患有ANA的无症状儿童应仔细观察,但不必停用抗惊厥药。

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