SHM Converge Scientific Abstract ePoster Gallery-Multi-Disciplinary Approach to Thrombotic Microangiopathy in Lupus and Antiphospholipid Syndrome

Pdf Summary

This case describes thrombotic microangiopathy (TMA), a syndrome marked by thrombocytopenia, microangiopathic hemolytic anemia, and kidney injury, in a 27-year-old man with systemic lupus erythematosus (SLE), class II lupus nephritis, triple-positive antiphospholipid syndrome (APLS), and immune thrombocytopenia.<br /><br />He underwent laparoscopic cholecystectomy for chronic cholecystitis and then developed worsening oliguric acute kidney injury despite IV fluids and immunosuppression adjustments. Imaging did not reveal a structural cause. Laboratory evaluation showed low complement, elevated anti-dsDNA, and positive antiphospholipid antibodies; testing for ADAMTS13 and complement factor H/I antibodies was negative. Peripheral smear did not show schistocytes.<br /><br />Kidney biopsy demonstrated mild mesangial hypercellularity consistent with class II lupus nephritis, but also significant TMA-like vascular and glomerular injury, including arteriolar thrombus and ischemic glomerular changes. The patient improved with eculizumab and temporary hemodialysis, and renal function eventually normalized without escalation of lupus-directed immunosuppression. This supported a diagnosis of secondary autoimmune TMA rather than progression of lupus nephritis.<br /><br />The report highlights that TMA can occur secondary to SLE, APLS, surgery, or other stressors and may mimic lupus nephritis flare or thrombotic thrombocytopenic purpura. Because diagnosis is challenging, a multidisciplinary approach and repeat assessment of complement, ADAMTS13, antiphospholipid, and other related studies are emphasized. Treatment options include corticosteroids, anticoagulation, dialysis, plasma exchange, mTOR inhibition, B-cell therapy, and complement blockade with eculizumab. The case underscores that TMA in lupus patients is associated with worse renal outcomes and requires early recognition and targeted management.

Asset Subtitle

Sabiha Armin

Meta Tag

Author List Andrew Zarker, Jeffrey Chen, Sabiha Armin

Category Clinical Vignettes

Concept Thrombotic Microangiopathy

Concept Thrombocytopenia

Concept Microangiopathic Hemolytic Anemia

Concept Renal Dysfunction

Concept Thrombotic Thrombocytopenic Purpura

Distinguished Non-Finalist

Presenter Organization University of Texas Health Science Center at Houston (UTHealth) Internal Medicine Program

Presenting Author Sabiha Armin

Track Adult

Keywords

thrombotic microangiopathy

systemic lupus erythematosus

antiphospholipid syndrome

lupus nephritis

acute kidney injury

eculizumab

complement blockade

hemolytic anemia

thrombocytopenia

kidney biopsy

Thrombotic Microangiopathy

Thrombocytopenia

Microangiopathic Hemolytic Anemia

Renal Dysfunction

Thrombotic Thrombocytopenic Purpura