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New-onset systemic lupus erythematosus in a long-term hemodialysis patient with
acute pleuritis and pneumonitis
#MMPMID28509090
Hiyamuta H
; Yamada S
; Yotsueda R
; Hasegawa S
; Nakano T
; Taniguchi M
; Tsukamoto H
; Kitazono T
; Tsuruya K
CEN Case Rep
2015[Nov]; 4
(2
): 139-144
PMID28509090
show ga
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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