SHM Converge Scientific Abstract ePoster Gallery-Thrombotic Microangiopathy Unveiling Atypical Sle in a Middle-Aged Hispanic Man

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This case describes a 48-year-old Hispanic man with no prior medical history who presented with two weeks of bilateral edema and gross hematuria. He was febrile and hypertensive, with nephritic syndrome on urinalysis, normocytic anemia, severe thrombocytopenia, positive direct antiglobulin test, low complement levels, and elevated inflammatory markers. Because of the combination of cytopenias and renal findings, lupus nephritis, cryoglobulinemia, and thrombotic microangiopathy (TMA) were considered.<br /><br />Although his ANA was positive and met SLICC criteria for systemic lupus erythematosus (SLE), other lupus-related serologies were negative, and his presentation lacked classic mucocutaneous or articular features. His kidney function worsened rapidly, resembling rapidly progressive glomerulonephritis. He was treated with high-dose IV steroids and rituximab, then transitioned to prednisone and mycophenolate.<br /><br />Renal biopsy was key to diagnosis and showed endothelial injury, mesangiolysis, and features of TMA without immune-complex deposition. Workup for atypical hemolytic uremic syndrome was negative. After treatment, renal function improved quickly, with creatinine falling to 1.5 mg/dL by day 7 and normalizing to 0.8 mg/dL, supporting SLE-associated renal TMA as the cause of his presentation.<br /><br />The report emphasizes that TMA is a rare but serious complication of SLE that can mimic TTP, HUS, or RPGN. It highlights the importance of early kidney biopsy and multidisciplinary evaluation when serologies are atypical or classic lupus features are absent. Prompt immunosuppressive therapy may lead to rapid renal recovery and prevent permanent kidney damage.

Asset Subtitle

Eugene J. Kim

Meta Tag

Author List Alireza Zarineh, Daniel Matassa, Eugene J. Kim, Mohammed Ayyad

Category Clinical Vignettes

Concept Systemic Lupus Erythematosus

Concept Thrombotic Microangiopathy

Concept Nephritic Syndrome

Concept Kidney Biopsy

Concept Immunosuppressive Therapy

Distinguished Non-Finalist

Presenter Organization Rutgers New Jersey Medical School

Presenting Author Eugene J. Kim

Track Adult

Keywords

systemic lupus erythematosus

renal thrombotic microangiopathy

kidney biopsy

nephritic syndrome

gross hematuria

thrombocytopenia

lupus nephritis

rapidly progressive glomerulonephritis

rituximab

mycophenolate

Systemic Lupus Erythematosus

Thrombotic Microangiopathy

Nephritic Syndrome

Kidney Biopsy

Immunosuppressive Therapy