Living in Trinidad and Tobago and practicing medicine is quite interesting and rewarding. Our country’s history of folklore mixes readily within society, and this has also entered people’s understanding of disease. Sometimes, as physicians, we hear- “the child was bitten by a socouyant” (a flying fireball). Or we would hear- “the child is possessed by a jinn” (an evil spirit), if their behaviour appears psychotic or inappropriately aggressive.
One morning, whilst listening to a nice overview of Lupus from the American College of Rheumatology on the history of Lupus, I found it amazing to see folklore at work outside of our Caribbean Isle, albeit centuries ago. “Lupus” is Latin for “wolf” and in the Middle Ages this term was used to refer to the characteristic facial rash that some thought resembled the bite of a wolf.
I have heard mentions of “mad blood” or “bitten by a bat” for petechial rashes by parents, but never the reference of a wolf's bite. It may just be because the wolf is not native to our island. Whilst we must understand and respect the culture in which we live, it is important for patients to be educated and willing to accept new knowledge of the human body, especially for diseases that we have studied tremendously over the last century.
We have advanced a long way in our understanding of lupus being a “wolf’s bite”.
Lupus is a real condition. Granted that the rash may also be described as a beautiful butterfly shape on the nasal bridge, the disease can be as aggressive as an alpha wolf defending his pack. We have advanced a long way in our understanding of lupus being a "wolf's bite." Its pathophysiology is described in volumes of immunology and rheumatology articles and books, with societies in the UK and USA producing clear guidelines to help physicians diagnose and manage this condition.
Lupus is not only a condition for adults but can also occur in children. In fact, 15-20% of adult lupus cases present in childhood.
In fact, 15-20% of adult lupus cases present in childhood.
Childhood lupus also known as juvenile onset systemic lupus erythematosus (SLE), is a rare autoimmune disease that affects 1 - 6 children in every 100 000 persons under the age of 18. It is a chronic condition that is more common in females and appears to have a greater genetic tendency than adult-onset lupus. It tends to be more aggressive, requiring more intense therapies and as a result actually has a higher mortality than in adults.
Lupus is a condition whereby the body’s immune system attacks its own organs. This makes diagnosing childhood lupus a challenge as its symptoms are diverse. It can mimic other diseases like rosacea, rheumatoid arthritis and systemic vasculitis. Symptoms include chronic fatigue, prolonged fever, joint pains, seizures or kidney issues. Even though the face rash is characteristic in up to 80% of the condition some children can show no skin changes and may need blood tests and urine tests to assist the clinician in making a diagnosis.
Treatment usually follows a holistic approach with many disciplines involved. Besides having a rheumatologist as the clinical lead, these kids may also need inputs from specialties like neurology, dermatology, nephrology, psychiatry and occupational therapy. Medications may include glucocorticoids, hydroxychloroquine and other immunosuppressant therapies like monoclonal antibodies. On a positive note, the 10-year survival is now at 90%. Children and family members require support and counseling in this lifelong battle against lupus.
If a child has a butterfly rash or any symptom that you are concerned about, it is recommended that they see a paediatrician who can assist with making a diagnosis.
Dr. Zafir W. Latchan
BMedSci. (Hons), MBBS (UWI)
PGDip. Paediatric Emergency Medicine (Edin)
MRCPCH (Lon),
EULAR Certificate in Paediatric Rheumatology