Development of Systemic Lupus erythematosus in a Patient on Hemodialysis

Hernández-Jaras, Julio; Bernis, Carmen; Paraíso, Vicente; Barril, Guillermina; Álvarez, Vicente; Traver, J. A.

doi:10.1159/000168426

Cited by 9 publications

(5 citation statements)

References 8 publications

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“…Several cases of new-onset SLE after dialysis initiation have been reported previously. [5][6][7][8] Hiyamuta et al 8 reported a 61-year-old woman who developed SLE 25 years after the initiation of dialysis. She presented with arthritis and pleuritis.…”

Section: Discussionmentioning

confidence: 99%

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A Case of New-Onset Systemic Lupus Erythematosus With Serositis in a Maintenance Hemodialysis Patient

Kosugi

Yoshida

Yoshimoto

et al. 2021

Clin Med Insights Case Rep

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A 61-year-old woman with a 4-year history of maintenance hemodialysis due to end-stage renal disease of unknown cause was admitted because of a recurrent fever and abdominal pain lasting for 3 months. She had rheumatoid arthritis as a complication and had taken sulfasalazine for over 4 years. Laboratory data revealed thrombocytopenia, hypocomplementemia, a high C-reactive protein level, and positivity for antinuclear antibody and anti-double strand DNA antibody. Gallium scintigraphy showed pericarditis, pleuritis, and peritonitis. Nonscarring alopecia was also noted. She was diagnosed as having systemic lupus erythematosus (SLE). Drug-induced lupus elicited by sulfasalazine was ruled out because the symptoms did not improve even after the discontinuation of the drug upon admission. Oral prednisolone treatment markedly improved her symptoms and laboratory data. However, she later died of sepsis arising from proctitis on day 71 of admission. This report underscores the necessity of considering new-onset SLE in patients with unexplained fever and serositis, including pleuritis, peritonitis, or pericarditis, even if they are receiving maintenance dialysis.

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Section: Discussionmentioning

confidence: 99%

“…3,4 Thus, only a few cases of new-onset SLE during maintenance dialysis therapy have been reported. [5][6][7][8] Here, we report a rare case of a 61-year-old woman who newly developed SLE with serositis, including pleuritis, peritonitis, and pericarditis, 4 years after the introduction of hemodialysis for end-stage renal disease.…”

Section: Introductionmentioning

confidence: 99%

A Case of New-Onset Systemic Lupus Erythematosus With Serositis in a Maintenance Hemodialysis Patient

Kosugi

Yoshida

Yoshimoto

et al. 2021

Clin Med Insights Case Rep

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“…Hernandez-Jaras et al [6] described an 18-year-old woman with new-onset SLE that occurred 2 years after the initiation of hemodialysis treatment for renal disease of an unknown cause. She developed oral ulcers, seizure, pericardial effusion, pancytopenia, positive ANA, and positive anti-dsDNA.…”

Section: Discussionmentioning

confidence: 99%

New-onset systemic lupus erythematosus in a long-term hemodialysis patient with acute pleuritis and pneumonitis

et al. 2014

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A 61-year-old woman, with a 25-year history of maintenance hemodialysis due to end-stage renal disease of unknown causes, was admitted because of systemic joint pain and inflammatory response of unknown etiology that persisted for 1 month. Laboratory data on admission revealed leukocytopenia, lymphocytopenia, high serum C-reactive protein, and positivity for antinuclear antibody (ANA) and anti-double strand DNA. After admission, she progressively developed cough and dyspnea. A chest radiograph revealed bilateral ground glass opacity and pleural effusion. A thoracentesis revealed lupus erythematosus cells, suggesting lupus pleuritis. A chest computed tomography showed a pattern of diffuse alveolar damage compatible with acute lupus pneumonitis. She fulfilled the American Rheumatism Association diagnostic criteria for systemic lupus erythematosus (SLE). Methylprednisolone pulse therapy followed by oral prednisone treatment improved the clinical symptoms and laboratory abnormalities. ANA was negative 25 years earlier when she first started hemodialysis and she had neither clinical nor serological abnormalities related to SLE during the last 25 years. Further, she had neither received drugs that can cause drug-induced SLE, nor had a history of ultraviolet ray exposure, pregnancy, blood transfusion, trauma and smoking. This report suggests that new-onset SLE can develop in patients undergoing long-term dialysis. Hence, when we encounter dialysis patients with arthralgia and/or respiratory disorders, we should consider the possibility of new-onset SLE.

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“…Significant decrease in ANA titer can be expected within two months of initiation of hemodialysis; in most patients, titers decrease to 1:80 or less and serum complement (C3) levels return to normal (16). Flares of systemic lupus erythematosus (SLE) in chronically dialyzed patients may involve multiple organ systems and be associated with serologic abnormalities (17)(18)(19)(20). These studies confirm that dialysis patients experience less severe extra-renal manifestations, a decreased need for immunosuppressive medications and a significantly decreased anti-double stranded DNA (anti-dsDNA) levels.…”

Section: Anti-nuclear Autoantibodiesmentioning

confidence: 99%

Autoantibodies and Other Autoimmune Serologic Abnormalities in Dialysis Patients

Wilkowski

Bolton

1995

Seminars in Dialysis

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Development of Systemic Lupus erythematosus in a Patient on Hemodialysis

Cited by 9 publications

References 8 publications

A Case of New-Onset Systemic Lupus Erythematosus With Serositis in a Maintenance Hemodialysis Patient

A Case of New-Onset Systemic Lupus Erythematosus With Serositis in a Maintenance Hemodialysis Patient

New-onset systemic lupus erythematosus in a long-term hemodialysis patient with acute pleuritis and pneumonitis

Autoantibodies and Other Autoimmune Serologic Abnormalities in Dialysis Patients

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