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

Abstract

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.

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

“…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.…”

“…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.…”