Late-Onset Systemic Lupus Erythematosus with Rapidly Progressive Glomerulonephritis Presentation: Case Report

Abstract

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease with multisystem involvement that mainly affects young women; however, there is a distinct phenotype of late-onset SLE, generally defined in the literature, with onset after the age of 50 years, with a milder course, a group in which renal involvement is atypical, worsening clinical outcomes.

Objective: It is important to know this atypical presentation of the disease to include it as a differential diagnosis in patients and to make a timely diagnosis to avoid adverse clinical outcomes.

Case presentation: We present the case of a 57-year-old man who consulted with deterioration of his functional class associated with edema, with recent history of deep vein thrombosis and arterial hypertension, laboratory tests showed elevated azotemia, moderate metabolic acidosis, proteinuria in nephrotic range with glomerular hematuria, low serum albumin levels and positive ANA (antinuclear antibodies).

Discussion and conclusion: Renal biopsy results indicated membranoproliferative glomerulonephritis with subendothelial immune complex deposits and “full house” immunofluorescence pattern. Rapidly progressive glomerulonephritis (RPGN) was considered as the initial manifestation of late-onset SLE, requiring renal replacement therapy. The patient received treatment with high-dose intravenous steroid and cyclophosphamide, without further deterioration of his clinical status or renal function; however, the patient continued to require hemodialysis.