Epistaxis and Hypertensive Emergency as the First Signs of Lupus Nephritis.

Systemic lupus erythematosus is a multisystem autoimmune disease that predominantly affects young females. This case report describes a rare presentation of a hypertensive emergency as the initial manifestation of lupus nephritis (LN) in a 64-year-old female with normal serum creatinine at presentation. The patient initially presented with epistaxis and severe hypertension (221/127 mmHg). Further evaluation revealed non-nephrotic range proteinuria and microscopic hematuria. Autoimmune studies and renal biopsy confirmed diffuse proliferative LN (Class IV). Treatment with corticosteroids and cyclophosphamide yielded a favorable clinical response.