Up to 10% of systemic lupus erythematosus (SLE) cases are drug-induced; hence, they are called drug-induced lupus syndrome (DILS). Antinuclear antibody (ANA) should be present to diagnose SLE and DILS. ANA-negative lupus is very rare; therefore, it presents a diagnostic challenge. In the medical literature, two cases of ANA-negative hydralazine-induced lupus syndrome (HILS) have been described within the last year. Here, we present the third such case of HILS with negative ANA serology in a patient who developed considerable pericardial effusion. The association between ANA-negative HILS and pericardial effusion warrants future research.

We report a case of renal failure associated with ingestion of Chinese herbal weight loss supplement called Zi Xiu Tang Bee Pollen. A 33 year old African American female who had been ingesting Zi Xiu Tang Bee Pollen for about one year in duration. The patient presented to our facility with renal failure requiring dialysis for one month from unknown etiology. The patient had a normal creatinine level a few months prior to starting dialysis. The patient had no additional medical history. Her urine studies were positive for sterile pyuria, suggestive of interstitial nephritis. She subsequently underwent a kidney biopsy which showed severe chronic interstitial nephritis due to Zi Xiu Tang Bee Pollen. The Chinese herbal supplement was discontinued, but patient remained dialysis dependent. Our literature search showed one other reported case of bee pollen associated with acute interstitial nephritis that required short term hemodialysis with renal recovery after discontinuation of supplement. This unique case highlights the growing health risks posed by nonprescription diet supplements and they can potentially add to the increasing burden of kidney disease.

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Fibrillary glomerulonephritis (FGN) is a rare cause of glomerulonephritis with poor prognosis. No standard treatment exists. We report a case of crescentic FGN presenting as rapidly progressing renal failure needing hemodialysis and treated based on Euro lupus nephritis trial protocol of low dose cyclophosphamide and glucocorticoid for induction followed by azathioprine maintenance. Patient responded very well to this therapy and was able to get off hemodialysis and continues with stable stage 3 CKD after 1 year follow up.