{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T10:57:35Z","timestamp":1775127455209,"version":"3.50.1"},"reference-count":11,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Reports"],"abstract":"<jats:p>Background: Systemic lupus erythematosus (SLE) may present with heterogeneous clinical manifestations in pediatric patients. Although infections are a major cause of morbidity and mortality in SLE, severe bacterial infections rarely represent the presenting clinical event leading to diagnosis. Case description: We report the case of a 13-year-old boy diagnosed with SLE with Sj\u00f6gren\u2019s syndrome overlap who presented with pneumococcal sepsis. The patient was admitted with high-grade fever and facial swelling, and blood cultures grew Streptococcus pneumoniae. Although an initial clinical response to antibiotic therapy was observed, fever subsequently recurred, accompanied by persistent systemic symptoms and progressive laboratory abnormalities. Further investigations revealed hematologic abnormalities, serosal involvement, renal disease, and a characteristic autoantibody profile. The patient fulfilled the 2019 ACR\/EULAR classification criteria for SLE after comprehensive autoimmune evaluation. The overlap with Sj\u00f6gren\u2019s syndrome was supported by the autoantibody profile and imaging findings involving the parotid glands. Following treatment with intravenous methylprednisolone pulses, oral prednisone, hydroxychloroquine, and mycophenolate mofetil, the patient showed rapid clinical improvement and sustained remission. Conclusions: This case highlights that severe invasive bacterial infection may occasionally be the clinical circumstance that leads to the diagnosis of pediatric systemic lupus erythematosus. Persistent systemic inflammation or evolving multisystem involvement despite appropriate antimicrobial therapy should prompt consideration of an underlying autoimmune disease, even in patients without a prior history of immune dysfunction.<\/jats:p>","DOI":"10.3390\/pediatric18020051","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T09:26:12Z","timestamp":1775121972000},"page":"51","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pneumococcal Sepsis Revealing Pediatric Systemic Lupus Erythematosus with Sj\u00f6gren\u2019s Syndrome Overlap: A Case Report"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3205-106X","authenticated-orcid":false,"given":"Francesco","family":"Accomando","sequence":"first","affiliation":[{"name":"Department of Pediatrics, G.B. Morgagni\u2013L. Pierantoni Hospital, Azienda Unit\u00e0 Sanitaria Locale Romagna, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4749-211X","authenticated-orcid":false,"given":"Vittorio","family":"Albertazzi","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Dialysis, G.B. Morgagni\u2013L. Pierantoni Hospital, Azienda Unit\u00e0 Sanitarlia Locale Romagna, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Girelli","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, G.B. Morgagni\u2013L. Pierantoni Hospital, Azienda Unit\u00e0 Sanitaria Locale Romagna, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michela","family":"Biscarini","sequence":"additional","affiliation":[{"name":"Department of Radiology, G.B. Morgagni\u2013L. Pierantoni Hospital, Azienda Unit\u00e0 Sanitaria Locale Romagna, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2072-3559","authenticated-orcid":false,"given":"Melodie O.","family":"Aric\u00f2","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, G.B. Morgagni\u2013L. Pierantoni Hospital, Azienda Unit\u00e0 Sanitaria Locale Romagna, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5735-1949","authenticated-orcid":false,"given":"Enrico","family":"Valletta","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, G.B. Morgagni\u2013L. Pierantoni Hospital, Azienda Unit\u00e0 Sanitaria Locale Romagna, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.jpeds.2007.09.019","article-title":"Clinical and laboratory characteristics and long-term outcome of pediatric systemic lupus erythematosus: A longitudinal study","volume":"152","author":"Hiraki","year":"2008","journal-title":"J. Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/j.pcl.2018.04.001","article-title":"Systemic Lupus Erythematosus, Sj\u00f6gren Syndrome, and Mixed Connective Tissue Disease in Children and Adolescents","volume":"65","author":"Tarvin","year":"2018","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1097\/01.md.0000091181.93122.55","article-title":"Morbidity and mortality in systemic lupus erythematosus during a 10-year period: A comparison of early and late manifestations in a cohort of 1000 patients","volume":"82","author":"Cervera","year":"2003","journal-title":"Medicine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"A78","DOI":"10.1136\/adc.2011.212563.182","article-title":"Pneumococcal sepsis as the first presentation of systemic lupus erythematosus (SLE) in a six year old boy","volume":"96","author":"Elliott","year":"2011","journal-title":"Arch. Dis. Child."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"315","DOI":"10.2147\/IJGM.S105070","article-title":"Streptococcus pneumoniae sepsis as the initial presentation of systemic lupus erythematosus","volume":"9","author":"Erdem","year":"2016","journal-title":"Int. J. Gen. 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Immun."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/0049-0172(90)90059-O","article-title":"Functional asplenia in systemic lupus erythematosus","volume":"20","author":"Piliero","year":"1990","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1136\/annrheumdis-2022-222574","article-title":"EULAR\/PRES recommendations for vaccination of paediatric patients with autoimmune inflammatory rheumatic diseases: Update 2021","volume":"82","author":"Jansen","year":"2023","journal-title":"Ann. Rheum. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2702","DOI":"10.1016\/j.ejrad.2011.12.034","article-title":"Diagnostic accuracy of parotid CT for identifying Sj\u00f6gren\u2019s syndrome","volume":"81","author":"Sun","year":"2012","journal-title":"Eur. J. 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