A Rare Case of Antinuclear Antibody-Negative Systemic Lupus Erythematosus Presenting With Generalized Lymphadenopathy as the Initial Manifestation

    October 2025 in “ Cureus ”
    Nazifa Ibnath, Rajib Biswas
    TLDR A 16-year-old girl with lupus symptoms improved with treatment despite negative ANA tests.
    This article discusses a rare case of antinuclear antibody (ANA)-negative systemic lupus erythematosus (SLE) in a 16-year-old South Asian female, who presented with generalized lymphadenopathy, fever, alopecia, oral ulcers, purpuric rashes, and polyarthritis. Despite the absence of detectable ANA, the patient had strongly positive anti-double-stranded DNA antibodies and met four American College of Rheumatology classification criteria for SLE. The case highlights the diagnostic challenges of ANA-negative SLE, particularly in South Asia, and underscores the importance of comprehensive diagnostic criteria like the SLICC 2012. The patient responded well to corticosteroid and hydroxychloroquine therapy, emphasizing the need for early recognition and treatment in pediatric patients with multisystem involvement.
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