Pediatric emergency medicine trisk 2935 2935
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primary disease, or a combination of both. In addition to usual laboratory testing,
urinalysis, procalcitonin, and quantitative CRP provide a rapid and general overview of
the patient’s well-being. CH50 (or C4), C3, ANA, and anti-ds DNA, and extractable
nuclear antigen (ENA) and possibly antiphospholipid antibody titers should be
obtained in order to assess the degree to which the patient’s SLE is active. An elevated
procalcitonin and/or CRP without other evidence of active SLE is highly suggestive of
bacterial infection. Blood cultures are mandatory if no source of fever is apparent after
a complete physical examination, and clinicians should have a low threshold for
obtaining a chest x-ray, and for culturing CSF and other fluids when indicated. In most
cases, children with SLE who develop fever without a readily apparent source should
be given antibiotics pending culture results; abnormal splenic function places them at
increased risk of rapid development of bacteremia and overwhelming sepsis from
encapsulated organisms.
