Medicine · 2025
A case report and literature review on new-onset systemic lupus erythematosus leading to thrombocytopenia in a hemodialysis patient.
СтатьяКлинический случайОбзорНазвание и аннотация: Перевод в очереди
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Zhang Zhe, Lai Yunshi, Liu Xiaoyi, Ye Peiyi, Kong Yaozhong, Xie Chao
Аннотация
RATIONALE: Systemic lupus erythematosus (SLE) is a complex autoimmune disease that affects various organs. Disease activity in SLE may diminish following the initiation of dialysis in patients with end-stage renal disease.
PATIENT CONCERN: We report the case of a 69-year-old female patient with a prior diagnosis of IgA nephropathy who developed SLE characterized by severe thrombocytopenia after hemodialysis.
DIAGNOSES: The patient presented with fever, rash, polyarthralgia, thrombocytopenia, hemolytic anemia, positive antinuclear antibodies, anti-nucleosome antibodies, anticardiolipin antibodies, anti-β2-glycoprotein I antibodies, and decreased complement C3 and C4 levels. She was diagnosed with SLE complicated by hematological damage and immune thrombocytopenia.
INTERVENTIONS: The treatment included an intravenous infusion of 5% human immunoglobulin at 20 g/day for 5 days combined with an intravenous infusion of methylprednisolone at 500 mg/day for 3 days. Plasma exchange therapy was conducted a total of 3 times.
OUTCOMES: The patient was discharged with methylprednisolone and hydroxychloroquine treatment. The platelet count was stable, antinuclear antibody, anti-nucleosome antibody, antiphospholipid antibody, Coombs test, and complement C3 and C4 levels were normal after discharge.
LESSONS: In patients with unexplained thrombocytopenia, the possibility of SLE should be considered even after hemodialysis initiation.
PATIENT CONCERN: We report the case of a 69-year-old female patient with a prior diagnosis of IgA nephropathy who developed SLE characterized by severe thrombocytopenia after hemodialysis.
DIAGNOSES: The patient presented with fever, rash, polyarthralgia, thrombocytopenia, hemolytic anemia, positive antinuclear antibodies, anti-nucleosome antibodies, anticardiolipin antibodies, anti-β2-glycoprotein I antibodies, and decreased complement C3 and C4 levels. She was diagnosed with SLE complicated by hematological damage and immune thrombocytopenia.
INTERVENTIONS: The treatment included an intravenous infusion of 5% human immunoglobulin at 20 g/day for 5 days combined with an intravenous infusion of methylprednisolone at 500 mg/day for 3 days. Plasma exchange therapy was conducted a total of 3 times.
OUTCOMES: The patient was discharged with methylprednisolone and hydroxychloroquine treatment. The platelet count was stable, antinuclear antibody, anti-nucleosome antibody, antiphospholipid antibody, Coombs test, and complement C3 and C4 levels were normal after discharge.
LESSONS: In patients with unexplained thrombocytopenia, the possibility of SLE should be considered even after hemodialysis initiation.