Systemic lupus erythematosus (SLE) is a disease of children, including adolescents before and after puberty, and is called SL E in children and adolescents. It has become a disease of great concern among rheumatic diseases because of its high incidence, severe clinical symptoms, rapid development and poor healing than adult SLE. The incidence of SLE in children is about 0.6 per 100,000, with more females than males, and the incidence is higher in males than in adults [4]. It is more common in yellow and black races than in white races. Its etiology and pathogenesis are still unknown. The consensus view is that the pathogenesis is related to genetic factors and that environmental factors also play a very important role in its development. Infections and female hormones can promote the expression of genetic components of SLE, and children with positive Ro/SSA antibodies are closely associated with the development of SLE. Deng Danqi, Department of Dermatology and Venereology/Rheumatology, Second Affiliated Hospital of Kunming Medical University II Clinical manifestations Rash is the most common manifestation of SLE in children. We summarized the clinical and laboratory features of 53 cases of SLE in children. 44 out of 53 children had skin lesions (83.02%), including 5 males and 39 females. Rash was the most common first symptom (41.51%), followed by fever (20.75%) and arthralgia (20.75%). The most common type of rash was butterfly-shaped erythema (30 cases, accounting for 56.60% of all cases), followed by erythema of finger and toe tips and erythema of nail folds. Erythema multiforme-like lesions on the hands and feet, especially around the nails, were also characteristic. Other manifestations included photosensitivity in 17 cases (32.08%), alopecia in 8 cases (15.09%), oral ulcers in 5 cases (9.43%), and Raynaud’s phenomenon in 2 cases (3.77%). Most of the cases had both facial lesions and erythema of finger and toe tips, erythema of nail creases and frostbite like damage. Some children may have lesions similar to herpetiform aspergillosis, but these patients tend to have mild systemic damage. Discoid lupus erythematosus-like lesions and photosensitive erythema may occur in children with SLE, but are less common than in adults with SLE. Visceral damage is most common in children with renal lesions in 2/3 of children. The degree of involvement may range from mild glomerulonephritis to sudden renal failure. The causes of renal failure include active renal damage, renal vein or arterial thrombosis, and drugs that interfere with glomerular filtration or direct nephrotoxicity. Renal vein or arterial thrombosis is often associated with anticardiolipid antibodies. Pattaragarn et al. reported renal biopsy findings in 82 patients with lupus nephritis, with a maximum of 40 cases of type IV (48.8%), followed by type II (30.5%), type V (14.6%), type I (3.7%), and type III (2.4%). In 32 of our 53 cases, renal involvement was most common in proteinuria, followed by hematuria, and renal function tests were mostly in the normal range. Hematologic involvement is common in children, and Xie Yueqi in China reported 11 cases of pediatric SLE with hematologic abnormalities as the first manifestation, with autoimmune hemolysis being the most frequent. In our group, there were 25 cases of hematologic involvement, the most common of which was anemia, followed by leukopenia and thrombocytopenia, most of which were mild anemia and few of which were severe anemia. Pulmonary involvement is common in children with SLE. The statistics of SL E in Canadian children found that 77% of the patients had pulmonary involvement, but our patients had less pulmonary involvement, 35.85%. Pleurisy and pleural effusion were the most common. SLE pneumonia and pulmonary hemorrhage are among the leading causes of death in children with SLE. Cardiac lesions are less common in children with SLE, but occasionally the opposite may occur, manifesting as pericarditis myocarditis and mild valvular lesions. Cardiac tamponade may occur in a small number of patients. Cardiac enzyme elevation was 30.19% in 53 of our patients. Central nervous system lesions ranged from 20% to 60% and could be manifested as psychosis, sudden personality changes, seizures, chorea, transverse myelitis, peripheral neuropathy and pseudotumor cerebri. The neurological involvement in our department was 18.87% in 53 patients, mainly manifested as epilepsy in 8 cases, psychiatric symptoms in 1 case and lupus headache in 1 case. It was found that the mean time from onset to onset of CNS symptoms was 9.8 months in children with SLE, which was significantly lower than the mean of 25.3 months in the adult group. Cerebrospinal fluid examination, although not characteristic, can be used to exclude infections and other diseases and has exclusionary diagnostic significance. Gastrointestinal damage is common in children with SLE, with symptoms occurring in the order of liver damage, loss of appetite, nausea and vomiting, abdominal pain, diarrhea, oral ulcers, gastrointestinal bleeding, and abdominal distention. In our department, 47.17% of 53 patients had liver damage, 15.09% had splenomegaly, and 5.66% had pancreatitis. In addition, it is important to note that therapeutic drugs can also cause gastrointestinal symptoms. Skeletal and muscular system lesions are also common in children with SLE, with an incidence of 40% to 60% and some reports of up to 80%. Ischemic osteonecrosis is a serious complication in children with SLE, usually involving the hip and knee joints, due to the action of SLE itself and/or corticosteroids. Muscle damage in children with SLE is less common than in adults, and diffuse muscle weakness is mostly due to hormonal myopathy. The incidence of anti-Sm and anti-RNP antibodies is lower than that of adults. The incidence of anti-Ro/SSB and anti-La/SSB antibodies was similar to that of adult patients, and hypergammaglobulinemia was common in children with SL E.