An unusual case of ANA negative systemic lupus erythematosus presented with vasculitis, long-standing serositis and full-house nephropathy.
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that may affect any organ of the body. We report here an unusual case of seronegative SLE presented as vasculitis with rash, lower gastrointestinal system bleeding and acute renal failure. The patient was a 13-year-old boy, with abdominal distention, pretibial edema, arthritis and petechia on bilateral ankles. He had deteriorated renal functions (creatinine 1.65 mg/dl), hypoalbuminemia (1.6 g/dl) and hypocomplementemia with nephrotic range proteinuria and hematuria. He developed pleural effusion and peritonitis. Serum ANA, anti dsDNA, p ANCA, c ANCA, anticardiolipin IgM and IgG titers were negative. A renal biopsy was performed which revealed diffuse proliferative glomerulonephritis with full-house staining pattern in immunofluorescent microscopic examination suggesting Class IV Lupus Nephritis. He was administered a total of six courses of monthly intravenous pulse methyl prednisolone, dipyridamole, oral cyclophosphamide followed by azothiopirine and oral prednisolone therapy. The renal functions and serum albumin levels turned normal but peritonitis persisted and disappeared after the third pulse steroid therapy. In conclusion, we presented this patient to remind the possibility of SLE in such seronegative patients with unusual findings in order to avoid the delay in the management of this disease with high mortality and morbidity if not treated. Full-house nephropathy is an important clue especially for the diagnosis of ANA negative SLE.
Pediatric Nephrology, Dr Sami Ulus Children Hospital, Ankara, Turkey. acaltik@hotmail.com
Aysun
A
Caltik
Gülay
G
Demircin
Mehmet
M
Bülbül
Ozlem
O
Erdogan
Sare G
SG
Akyüz
Nilüfer
N
Arda
D000284:Administration, Oral; D000293:Adolescent; D000974:Antibodies, Antinuclear / Q000097:blood; D001379:Azathioprine / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D004176:Dipyridamole / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015432:Glomerulonephritis, Membranoproliferative / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007275:Injections, Intravenous; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D008181:Lupus Nephritis / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D010538:Peritonitis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use; D020551:Pulse Therapy, Drug; D051437:Renal Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome; D014657:Vasculitis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology
D000974:Antibodies, Antinuclear; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D004176:Dipyridamole; D003520:Cyclophosphamide; D011239:Prednisolone; D001379:Azathioprine; D008775:Methylprednisolone