Bullous systemic lupus erythematosus and membranous lupus nephritis in a Filipino child

@#<p style="text-align: justify;">Bullous eruptions are rare cutaneous manifestations of systemic lupus erythematosus. We report a case of an 8-year old Filipino girl with vesiculobullous systemic lupus erythematosus (SLE) and membranous lupus nephritis on kidney biopsy who presented with clinical nephrotic features of generalized edema, proteinuria, hypoalbuminemia and hyperlipidemia. The 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE were met. Immunohistopathologic examination of the skin lesion revealed a sub-epidermal split with neutrophilic infiltrates along the dermo-epidermal junction, moderate perivascular, periadnexal and interstitial infiltrates composed of predominantly neutrophils with neutrophilic dusts, lymphocytes, plasma cells, rare eosinophils and increased dermal mucin. Direct immunofluorescence showed strong continuous linear IgG deposits along the basement membrane and weak linear IgM and IgA deposition along the basement membrane zone (BMZ). To our knowledge, this is the first report of vesiculobullous SLE in a Filipino child. This case is a rare form of cutaneous lupus in children. Bullous SLE (BSLE) should be considered in the differential diagnosis of children presenting with generalized bullous eruptions.</p>

Diagnostic accuracy of Renal Angina Index in predicting Acute Kidney Injury in pediatric patients with Sepsis: A Philippine tertiary hospital experience

Background@#The coexistence of acute kidney injury (AKI) in sepsis contributes significantly to morbidity and mortality rates. Traditional diagnostic markers still pose variable limitations in early AKI prediction. The use of renal angina index (RAI) as a clinical predictive tool for AKI is an emerging concept.@*Objectives@#To determine the diagnostic accuracy of RAI in predicting AKI in patients with sepsis@*Methodology@#This is a five-year retrospective cohort study conducted at the Philippine General Hospital (PGH). Records of eligible patients with sepsis were reviewed. RAI was calculated based on the composite of risk factors and clinical evidence of injury on day 0 of admission stratifying subjects into two groups: RAI (-) and RAI (+) for those with scores ≥ 8. Prediction of AKI with the RAI was analyzed.

14 year old male with oliguria and respiratory distress- What is your diagnosis?

@#A 14 year old male from Quezon City Manila was admitted due to oliguria. He presented with 7 days of intermittent fever associated with malaise, photophobia with redness of the eyes. A few hours before admission, he developed repetitive vomiting with decreased urine output. He denied any muscle pain, change in his sensorium or seizure episode. He had a history of wading in flooded waters.