Recurrent Cutaneous Lupus Flare with Photosensitivity, Palmar Plantar Hyperpigmented Papules, and Mild Proteinuria Following Abrupt Medication Cessation in a 10 Years Old Boy: A Case of Juvenile Systemic Lupus Erythematosus

Abstract

Juvenile systemic lupus erythematosus (JSLE) is a rare but aggressive autoimmune disease in children, with boys comprising only 10–20% of cases. Cutaneous manifestations are often the initial or predominant feature, yet atypical palmar-plantar lesions and flares triggered by medication non-adherence remain under-emphasised in the literature. We describe a 10-year-old Indian boy who presented with an 18-day history of multiple erythematous plaques over the face, upper limbs and trunk, hyperpigmented papules on bilateral palms and soles, facial puffiness, photosensitivity, and low-grade fever. He had discontinued prednisolone and hydroxychloroquine four days earlier after completing treatment for a similar episode six months previously that included seizures. Laboratory findings showed elevated spot urine protein-creatinine ratio (0.8), proteinuria (++), thrombocytosis, neutrophilia, and raised liver enzymes. Abdominal ultrasonography was normal. A provisional diagnosis of JSLE flare with predominant cutaneous and mild renal involvement was made. Re-initiation of oral prednisolone and hydroxychloroquine, along with sun protection and topical care, led to rapid clinical improvement within two weeks. This case underscores the critical role of medication adherence in preventing JSLE flares and highlights hyperpigmented palmar-plantar papules as a valuable cutaneous clue in paediatric lupus. Early recognition and prompt re-treatment in resource-limited settings can avert organ damage.