RELATED CHAPTERS Signs and Symptoms Coma: Chapter 17 Edema: Chapter 25 Gastrointestinal Bleeding: Chapter 33 Hypertension: Chapter 37 Pain: Abdomen: Chapter 53 Seizures: Chapter 72 Medical, Surgical, and Trauma Emergencies Cardiac Emergencies: Chapter 86 Gastrointestinal Emergencies: Chapter 91 Infectious Disease Emergencies: Chapter 94 Neurologic Emergencies: Chapter 97 Pulmonary Emergencies: Chapter 99 Renal and Electrolyte Emergencies: Chapter 100 Abdominal Emergencies: Chapter 116 Neurosurgical Emergencies: Chapter 122 Behavioral and Psychiatric Emergencies: Chapter 126 SYSTEMIC LUPUS ERYTHEMATOSUS CLINICAL PEARLS AND PITFALLS The most common initial symptoms are the gradual onset of fever, fatigue, and generalized lymphadenopathy The clinical presentation is highly variable and may include multiple body systems The classic malar rash is present in only one-half of pediatric patients at presentation Infection is the major cause of mortality in childhood systemic lupus erythematous (SLE) because of immune dysregulation inherent in the disease and the immunosuppressant medications used to treat SLE Patients taking corticosteroids may require stress doses during acute febrile illness Corticosteroids may mask the symptom of pain