Abstract

A CASE REPORT ON DIFFICULTY IN TREATING SYSTEMIC LUPUS ERYTHEMATOSUS WITH LUPUS NEPHRITIS - CLASS 4 RADIALLY PROGRESSIVE GLOMERULONEPHRITIS (RPGN)

Dr. Wajeeha Qhudsia Siddiqua*, Dr. Ayesha Sara, Dr. Pranitha Rachel, Dr. Ayesha
Ambereen and Dr. Sarath Chandra Mouli Veeravalli

ABSTRACT

This case report details the management challenges faced in a 31-yearoldfemale with systemic lupus erythematosus (SLE) progressing toClass 5 lupus nephritis with Class 3 features, and associated severecomplications. Initially presenting with symptoms of exertionaldyspnea, vomiting, and acute kidney injury, the patient’s conditionrapidly deteriorated despite ongoing treatment with mycophenolatemofetil (MMF) and steroids. Complications included severe pulmonaryarterial hypertension, myocarditis with new-onset mitral regurgitation,and cytomegalovirus (CMV)-associated gastrointestinal symptoms.The complexity of treatment was exacerbated by the progressive natureof lupus nephritis, from Class 2 to Class 5, and the presence ofmultiple organ system involvement. The multidisciplinary approachincluded aggressive immunosuppressive therapy with monoclonalantibodies, cyclophosphamide, and antiviral agents, alongsidesupportive measures for cardiovascular and gastrointestinal issues.  This case underscores the difficulty in managing severe SLE with multi-organ involvement,highlighting the need for individualized and dynamic treatment strategies, continuousmonitoring, and collaborative care to address the evolving clinical challenges and improvepatient outcomes.

Keywords: systemic lupus erythematosus, acute kidney injury, pulmonary arterial hypertension, myocarditis, lupus nephritis, rapidly progressive glomerulonephritis.