Chronic Immune Thrombocytopenia and Hashimoto’s Hypothyroidism in an Adolescent: Presentation and Implications

Table 2

Diagnostic criteria for systemic lupus erythematosus and Sjogren syndrome.

Systemic lupus erythematosus	Sjogren syndrome
Clinical criteria	1. Ocular symptoms: a positive response to at least one of the following questions:
(i) Acute cutaneous lupus	(i) Have you had daily, persistent, troublesome dry eyes for more than 3 months?
(ii) Chronic cutaneous lupus	(ii) Do you have a recurrent sensation of sand or gravel in the eyes?
(iii) Oral or nasal ulcers in the absence of other causes	(iii) Do you use tear substitutes more than 3 times a day?
(iv) Nonscarring alopecia	2. Oral symptoms: a positive response to at least one of the following questions:
(v) Synovitis involving 2 or more joints	(i) Have you had a daily feeling of dry mouth for more than 3 months?
(vi) Serositis in the absence of other causes	(ii) Have you had recurrently or persistently swollen salivary glands as an adult?
(vii) Renal disease	(iii) Do you frequently drink liquids to aid in swallowing dry food?
(viii) Neurologic disease	3. Ocular signs: a positive result for at least one of the following two tests:
(ix) Hemolytic anemia	Schirmer’s i test or Rose Bengal score or another ocular dye score
(x) Neutropenia or lymphopenia	4. Histopathology showing focal lymphocytic sialadenitis
(xi) Thrombocytopenia	5. Salivary gland involvement evident by US or scintigraphy or the flow test.
Immunologic criteria	6. Autoantibodies (anti-Ro (SSA) or anti-La (SSB) or both)
(i) High ANA level
(ii) High anti-dsDNA
(iii) Positive anti-Sm
(iv) Positive antiphospholipid antibodies
(v) Low complement levels
(vi) Positive direct Coombs test
To diagnose SLE, the child must meet 4 criteria at least one clinical and one immunologic or biopsy-proven nephritis with positive ANA and anti-dsDNA.	The presence of any four of the above six criteria is sufficient to diagnose Sjogren syndrome
Petri et al. (derivation and validation of systemic lupus international collaborating clinics (SLICC) classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012; 64:2677-2686.)	Vitali et al. (classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 2002; 61:554-558.)