Systemic Lupus Erythematosus in the Elderly That Debuts With an Organic Manifestation of Lupus Nephritis

Abstract

Systemic lupus erythematosus (SLE) is a systemic autoimmune condition with many clinical presentations. It is classically seen in young to middle-aged females and can present with cutaneous, renal, serosal, hematological, joint, and/or neurological manifestations at the time of diagnosis or may develop over the course of the disease. Late-onset SLE or SLE in the elderly is a subtype that differs from the classic SLE in age group, clinical presentation, involvement of organs, and severity. Here, we present the case of a geriatric Hispanic male noted to have worsening renal function. The patient was diagnosed with lupus nephritis (LN) upon obtaining serological markers and renal biopsy. LN, a renal sequela of SLE, presents with a full-house immunofluorescence pattern. LN, along with high titers of the antinuclear antibody (ANA) and/or anti-double-stranded DNA (anti-dsDNA) antibody, is an effective tool to diagnose SLE in patients without extrarenal manifestations of the disease. The patient was managed with glucocorticoids and mycophenolate mofetil therapy, which led to a rapid downtrend of creatinine, resulting in stabilization of renal function and deferring the need for a hemodialysis. This case highlights the topic of late-onset SLE presenting with LN in geriatric patients.

The efficacy and safety of cyclosporine in children with systemic lupus erythematosus: A protocol for systematic review and meta-analysis

“…Although recent advances in diagnosis and treatment have led to a remarkable improvement in the prognosis of SLE, 5 to 20% of patients continue to progress to end-stage renal disease within 10 years following the diagnosis of nephritis. [4,5] Childhood-onset SLE is rare, with an estimated annual incidence of 0.3 to 0.9/100,000 children. [6,7] The heterogeneous and complex nature of SLE means that diagnosis is often delayed until progression is advanced and several organs have become affected.…”

“…Although recent advances in diagnosis and treatment have led to a remarkable improvement in the prognosis of SLE, 5 to 20% of patients continue to progress to end-stage renal disease within 10 years following the diagnosis of nephritis. [4,5]…”