Sun-induced life-threatening lupus nephritis.
Photosensitivity is a widely known characteristic of both cutaneous and systemic lupus erythematosus (LE). However, sun-induced organ involvement is rarely reported in LE. We describe a 34-year-old woman who had been in complete remission of systemic LE for more than 8 years without treatment. After sunbathing, she developed acute sunburn followed by cutaneous LE in sun-exposed areas. Six weeks later, a lupus nephritis was diagnosed and high serum levels of antidouble-stranded (ds) DNA and anti-Ro/SSA antibodies were detected. Treatment with systemic cyclophosphamide and prednisolone led to septicemia requiring assisted ventilation for more than 2 weeks and repeated hemodialysis. Clinical remission was achieved 3 months later by the use of prednisolone and mycophenolate mofetile. Meanwhile, mild proteinuria persisted, anti-dsDNA antibodies normalized. We hypothesize that the sunburn-induced keratinocyte necrosis/apoptosis exposed intracellular antigens as trigger for the generation of autoantibodies that finally mediated immune-complex nephritis. The patient highlights the impact of UV light not only on skin but also on internal organ involvement in LE.
Schmidt
Enno
E
Department of Dermatology, University of Würzburg, Würzburg, Germany.
Tony
Hans-Peter
HP
Bröcker
Eva-Bettina
EB
Kneitz
Christian
C
D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D005260:Female; D006801:Humans; D008181:Lupus Nephritis / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D010787:Photosensitivity Disorders / Q000097:blood / Q000503:physiopathology*; D013471:Sunburn; D013472:Sunlight / Q000009:adverse effects*
D000974:Antibodies, Antinuclear