Late-Onset Systemic Lupus Erythematosus With Lupus Nephritis in a 74-Year-Old Male: A Brief Case and Review

Abstract

Rationale:Late-onset systemic lupus erythematosus (SLE) represents a specific subgroup of SLE, and although there is no strict age cut-off, 50 years is commonly used as the minimum age for disease onset. In this report, we present a case of a 74-year-old male with late-onset SLE and biopsy-proven lupus nephritis (LN).Presenting concerns of the patient:A 74-year-old male was referred to the nephrology clinic with a rapidly rising creatinine from a baseline of 60 µmol/L to 176 µmol/L. His labs showed pancytopenia, a positive antinuclear antibodies (ANA), and hypocomplementemia.Diagnoses:Renal biopsy showed focal proliferative glomerulonephritis that was immune-mediated and immunofluorescence showed C3, IgM, IgA, IgG, lambda, and C1q diffuse mesangial and glomerular basement membrane staining. Together these findings were in keeping with a diagnosis of stage III LN.Interventions:Treatment included hemodialysis and induction with pulse methylprednisone and cyclophosphamide. He was then placed on the Euro-Lupus Protocol.Outcomes:One year after the diagnosis, he was off dialysis, had no signs of fluid retention or uremia, and his creatinine had stabilized at ~ 330 µmol/L.Lessons learned:To the best of our knowledge, this case represents the oldest known biopsy-confirmed case of late-onset SLE and LN. Late-onset SLE is uncommon and often overlooked as classical symptoms such as malar rash or photosensitivity may not be present. The American College of Rheumatology (ACR) guidelines for treatment of LN can be applied to these patients but physicians should be cognizant of the fact that these patients may not tolerate immunosuppressive therapy as well as younger patients.

Class IV Lupus Nephritis in the Setting of Serologically Quiescent Disease and Normal Urine Sediment in a Patient with Late-Onset Systemic Lupus Erythematosus

“…However, there are varying opinions on the prognosis and mortality as one study showed more favorable result [26] compared to the other [27]. Of note is that the oldest reported age of a patient diagnosed with late-onset SLE and lupus nephritis is 74 years [28]. Our patient was diagnosed with late-onset SLE at 77 years and developed stage IV LN at 79 years.…”

Pulmonary manifestations of late-onset systemic lupus erythematosus: a case report

“…Serositis, interstitial pneumonia, and Sjogren's syndrome are frequently linked to late-onset SLE, while cutaneous manifestation, photosensitivity, arthritis, and nephritis occur less frequently. Elderly patients are frequently admitted to the hospital with nonspecifi c symptoms such as fatigue, weight loss, and acute kidney injury [7]. In the present case, in addition to exudative pleurisy and pericarditis, the patient had one of such musculoskeletal manifestations of SLE − unexpressed arthralgia of the small joints of the hand.…”

Case Report: A Rare Case of Lupus Nephritis Associated With Mantle Cell Lymphoma

“…The main differential diagnoses considered in our patient were whether the described associated glomerular disease is the paraneoplastic syndrome of lymphoma or that of concurrent primary lupus nephritis. However, new-onset SLE is uncommon in elderly male patients ( 8 ), and this patient notably has infiltration of mantle cell lymphoma cells in the renal interstitium and bone marrow. Besides, our patient achieved rapid remission of the glomerular disease and immune system remission after the first chemotherapy for MCL.…”