Childhood-onset systemic lupus erythematosus presenting with growth retardation and delayed puberty: a case report

Childhood-onset systemic lupus erythematosus (cSLE) is a chronic, multisystem autoimmune disease characterized by marked clinical heterogeneity and substantial morbidity. Although rash, arthritis, and renal involvement are common manifestations, atypical presentations may delay diagnosis. In rare cases, growth retardation and delayed puberty may precede typical systemic features, posing a diagnostic challenge. We report the case of a 12-year-old Chinese girl who presented to the endocrinology clinic with progressive growth retardation and delayed pubertal development. Comprehensive growth assessment demonstrated discordance among height velocity, weight gain, and pubertal progression. Further evaluation revealed proteinuria, hypoalbuminemia, generalized lymphadenopathy, and immunological abnormalities, leading to a diagnosis of cSLE. Following immunosuppressive therapy, systemic manifestations improved and laboratory indices gradually normalized; however, longitudinal follow-up showed that impairment in growth and pubertal progression persisted despite disease control. This case highlights that cSLE, although a rare cause of growth retardation and delayed puberty, should be considered in adolescents with unexplained short stature or pubertal delay, particularly when accompanied by proteinuria or immunological abnormalities. Early recognition and multidisciplinary management are essential to improve long-term growth and overall clinical outcomes.