This 11 year old boy, with a strong family history of lupus, developed multiple disseminated hypopigmented dermal papules on the chest, abdomen, back, and proximal extremities. A skin biopsy showed changes most consistent with granuloma annulare. He also complained of intermittent fevers and severe joint tenderness that interfered with normal activities. He had synovitis with prominent synovial swelling of the hands and feet, low complement levels (C3, C4), high titer antinuclear antibody, positive anti-double stranded DNA antibody, and lymphopenia. He denied photosensitivity, hair loss, and oral ulcerations, and his cardiac, pulmonary, and neurologic examinations were normal. Urinalysis and serum chemistries were also normal. He was being followed closely by his pediatrician, pediatric dermatologist and pediatric rheumatologist.
