Bilateral nephrectomy for the treatment of refractory lupus nephritis with features overlapping with thrombotic microangiopathy resembling thrombotic thrombocytopenia purpura.
We report a patient with a diagnosis of systemic lupus erythematosus who concurrently developed a syndrome of thrombotic microangiopathy that resembled thrombotic thrombocytopenic purpura. The patient underwent plasma exchange and immunosuppressive therapy for months before clinical improvement was finally achieved through bilateral nephrectomy. Ultimately, our patient died of disseminated aspergillosis from prolonged immunosuppression. We believe that recognition of bilateral nephrectomy as a potential treatment earlier in her course would have spared her this unfortunate demise. We hope that this review of current literature will help the reader to consider bilateral nephrectomy in patients with refractory systemic lupus erythematosus with clinical overlap of thrombotic microangiopathy resembling thrombotic thrombocytopenic purpura.
Department of Medical Education, Scripps Mercy Hospital, San Diego, CA, USA.
Tuan Van
TV
Mai
Kevin
K
Tse
Marc Kenneth
MK
Gehr
James
J
George
Joel
J
Baranski
Marin
M
Xavier
D001228:Aspergillosis / Q000209:etiology; D001706:Biopsy; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008181:Lupus Nephritis / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009392:Nephrectomy; D010951:Plasma Exchange; D011183:Postoperative Complications; D011696:Purpura, Thrombocytopenic / Q000473:pathology / Q000601:surgery*; D018805:Sepsis / Q000209:etiology; D057049:Thrombotic Microangiopathies / Q000473:pathology / Q000601:surgery*
D007166:Immunosuppressive Agents