Presentation of systemic lupus erythematosus in emergency department

Systemic lupus erythematosus (SLE) is a multisystem inflammatory disease that is often difficult to diagnose in the emergency department. It is an autoimmune disease with great variability in presentation and course. Moreover, the atypical or incomplete presentation is common in children and can result in delay in diagnosis. Consideration of the possibility of SLE is important when evaluating a patient with symptoms and/or signs suggesting multisystem disease. The emergency physician must maintain a high degree of suspicion for the early diagnosis and management of this important condition. We present 3 children who presented to emergency department with different initial manifestations of SLE.