SHM Converge Scientific Abstract ePoster Gallery-Menorrhagia in an Adolescent: An Unusual Presentation of Systemic Lupus Erythematosus

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This case report describes an unusual initial presentation of systemic lupus erythematosus (SLE) in a 14-year-old girl who came to the emergency department with severe weakness and dizziness from iron-deficiency anemia caused by heavy menstrual bleeding. Although pediatric SLE most often begins with symptoms such as joint pain, fever, or rash, this patient’s first major manifestation was menorrhagia.<br /><br />Her menstrual periods had become progressively longer and heavier since menarche at age 13, lasting 7–8 days with pad changes every 1–2 hours. On exam, she was pale and had small palatal and nasal ulcers. Laboratory studies showed profound anemia, prolonged PT/INR and PTT, and coagulation studies that did not correct with mixing, suggesting an inhibitor. She also had positive antiphospholipid antibodies, including anticardiolipin, beta-2 glycoprotein, and lupus anticoagulant, along with a strongly positive ANA and elevated anti-dsDNA, leading to the diagnosis of SLE.<br /><br />She was treated with prednisone, hydroxychloroquine, and azathioprine. For her menstrual bleeding, she was given progestin-only contraception rather than estrogen-containing oral contraceptives because lupus anticoagulant increases thrombosis risk, and estrogen could further raise that risk.<br /><br />The authors emphasize that adolescents with heavy menstrual bleeding should be carefully screened for a bleeding disorder and undergo coagulation testing when indicated. If PT/PTT abnormalities do not correct with mixing studies, an inhibitor such as lupus anticoagulant should be suspected. The report highlights the importance of considering SLE in adolescents with unexplained menorrhagia and coagulation abnormalities.

Asset Subtitle

Taylor M. Broome

Meta Tag

Author List Jennifer Rothman, Mary M. Buckley, Taylor M. Broome

Category Clinical Vignettes

Concept Menorrhagia

Concept Systemic Lupus Erythematosus

Concept Iron Deficiency Anemia

Concept Bleeding Disorder

Concept Mixing Study

Distinguished Finalist

Presenter Organization Duke University Hospital

Presenting Author Taylor M. Broome

Track Pediatric

Keywords

systemic lupus erythematosus

SLE

adolescent

menorrhagia

heavy menstrual bleeding

iron-deficiency anemia

lupus anticoagulant

antiphospholipid antibodies

coagulation abnormalities

pediatric autoimmune disease

Menorrhagia

Systemic Lupus Erythematosus

Iron Deficiency Anemia

Bleeding Disorder

Mixing Study