title: Scleroderma renal crisis precipitated by steroid treatment in systemic lupus erythematosus and scleroderma overlap syndrome.
abstract: BACKGROUND
  Connective tissue disorders can overlap in various ways. Patients may present with features of more than one specific disease without satisfying the diagnostic criteria and thereafter evolve into a specific disease entity. Occasionally, patients may fulfil simultaneously the diagnostic criteria of two or more diseases. Several cases of systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) overlap syndrome have been reported. SLE patients often develop lupus nephritis, the treatment of which is based on immunosuppression with corticosteroids (CS) and cytotoxic drugs. However, the use of high dose of CS has been associated with scleroderma renal crisis (SRC) in patient with SSc.
  
  
  METHODS
  a 43-year-old woman presented to the nephrology department of the Military hospital in Rabat, Morocco, in August 2011 with progressive dyspnea and oliguria. She was diagnosed as SLE and scleroderma overlap syndrome based on clinical and serological markers. Renal biopsy showed lupus nephritis. Immunosuppression consisting of high-dose steroid and cyclophosphamide pulses was given. There was response to treatment but 15 days later the course of the disease was complicated by scleroderma renal crisis evidenced by elevated blood pressure, deteriorating kidney function, hemolysis and thrombocytopenia. The patient was treated with perindopril and rapid reduction of steroid doses. This was followed by correction of hemolysis and thrombocytopenia. Two months later, the patient was off dialysis, but had chronic renal insufficiency with an estimated GFR of 25 ml/minute.
  
  
  CONCLUSIONS
  This report describes the occurrence of SRC in a patient with lupus nephritis and SSc/ SLE overlap syndrome who was treated by CS and cyclophosphamide.
authors.affiliation: Department of Nephrology, Hemodialysis and Kidney Transplantation, Military Hospital of Instruction, Mohammed V. Rabat, Morocco.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Alayoud
authors.forename: Ouadie
authors.initials: O
authors.lastname: Qamouss
authors.forename: Amine
authors.initials: A
authors.lastname: Hamzi
authors.forename: Mohammed
authors.initials: M
authors.lastname: Benyahia
authors.forename: Zouhir
authors.initials: Z
authors.lastname: Oualim
mesh_terms: D000328:Adult; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced*; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy*; D012594:Scleroderma, Localized / Q000139:chemically induced*; D012595:Scleroderma, Systemic / Q000150:complications*; D013577:Syndrome
chemical_list: D005938:Glucocorticoids