RAYMOND D . PRUITT , M . D . Systemic Lupus Erythematosus

DIR. JOSEPH J. BUNIM: The patient whose course we shall discuss today offers an unusual opportunity to study the history of lupus erythematosus. The life history of this child is almost coincident with the natural history of this disease. We are grateful to Dr. Bernard Benjamin of Brooklyn, New York, for this referral, and for his accurate and complete records. Dr. Alfred J. Bollet: The patient is a 7-yearold girl admitted to the Clinical Center with a history of intermittent febrile episodes accompanied by arthritis of 4 years' duration. At the age of 21⁄2 months, following an episode of pneumonia treated with penicillin, the patient developed an erythematous rash on the cheeks and nose and a persistent cough. This rash has varied in severity but has never entirely disappeared. At the age of 2 years she developed deformed, thickened fingernails and clubbing of her fingers, which have also persisted. Frequent cultures of the nails failed to reveal fungi, and the cause of these changes remained obscure. At the age of 3 years, redness, swelling, tenderness, and pain on motion of the right knee appeared for 24 hours, and 3 months later fever and painful swelling of both elbows and the left wrist. Within a week there were stiffness of the spine and pain in the temporomandibular joints. Subsequently, the feet, knees, and ankles were involved. The rash on her face spread and became more erythematous. Diagnoses of Still's disease and discoid lupus erythematosus were made. Treatment with cortisone abolished the fever;