A case report and literature review on new-onset systemic lupus erythematosus leading to thrombocytopenia in a hemodialysis patient

Abstract

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.

Keywords: case report; hemodialysis; systemic lupus erythematosus; thrombocytopenia.

Figure 1.

The renal pathological results of the patient. (A) HE staining results showing moderate mesangial proliferative IgA nephropathy with focal sclerosis. (B) Electron microscopy results confirming the diagnosis of IgA nephropathy.

Figure 2.

Radiographic and CT scan findings of the patient. (A) X-ray on July 13, 2023. (B) X-ray on July 27, 2023. (C) and (D) Chest CT scan results showing interstitial pneumonia on August 9, 2023.

Figure 3.

Clinical course during the treatment.