Systemic Lupus Erythematosus in the Elderly That Debuts With an Organic Manifestation of Lupus Nephritis

Abstract

Systemic lupus erythematosus (SLE) is a systemic autoimmune condition with many clinical presentations. It is classically seen in young to middle-aged females and can present with cutaneous, renal, serosal, hematological, joint, and/or neurological manifestations at the time of diagnosis or may develop over the course of the disease. Late-onset SLE or SLE in the elderly is a subtype that differs from the classic SLE in age group, clinical presentation, involvement of organs, and severity. Here, we present the case of a geriatric Hispanic male noted to have worsening renal function. The patient was diagnosed with lupus nephritis (LN) upon obtaining serological markers and renal biopsy. LN, a renal sequela of SLE, presents with a full-house immunofluorescence pattern. LN, along with high titers of the antinuclear antibody (ANA) and/or anti-double-stranded DNA (anti-dsDNA) antibody, is an effective tool to diagnose SLE in patients without extrarenal manifestations of the disease. The patient was managed with glucocorticoids and mycophenolate mofetil therapy, which led to a rapid downtrend of creatinine, resulting in stabilization of renal function and deferring the need for a hemodialysis. This case highlights the topic of late-onset SLE presenting with LN in geriatric patients.

Keywords: case report; hispanic; late-onset sle; lupus nephritis; mycophenolate mofetil; prednisone.

Figure 1. Serum creatinine trend.

Figure 2. Renal biopsy: light microscopy.

A: Crescentic and fibrinoid necrosis (50 μm); B: Endocapillary hypercellularity crescentic necrosis (50 μm).

Figure 3. Renal biopsy: immunofluorescent microscopy.

A: 3+ segmental tuft positivity for fibrinogen (100 μm); B: IgG positivity: granular global mesangial and glomerular capillary wall (50 μm); C: 2+ positivity for C1q (50 μm); and D: 3+ positivity for C3 (100 μm).

Figure 4. Renal biopsy: electron microscopy.

A: 4 μm; and B: 1 μm demonstrating subepithelial deposits.