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Lupus nephritis in a child with AIDS
V Mialou1, Y Bertrand, R Bouvier
1Service d'Immuno-hématologie Pédiatrique et de Transplantation de Moelle Osseuse, Hôpital Debrousse, Lyon, France.
Insights
This case report details a rare instance of lupus nephritis in a white child with acquired immunodeficiency syndrome (AIDS). Early treatment with steroids and antiretroviral therapy showed promising clinical and biologic improvement.
Area of Science:
- Nephrology
- Immunology
- Pediatrics
Background:
- Acquired immunodeficiency syndrome (AIDS) and lupus nephritis rarely co-occur, especially in Caucasian patients.
- Human immunodeficiency virus (HIV) infection in children requires diligent monitoring for opportunistic conditions.
- Lupus nephritis presents as a severe kidney disease often associated with autoimmune conditions.
Observation:
- A 12-year-old Caucasian male with untreated maternofetal HIV presented with nephrotic syndrome, renal failure, and pancytopenia.
- Renal biopsy confirmed severe lupus nephritis (WHO class IV) with immune deposits.
- The patient initially lacked clinical signs of systemic lupus erythematosus or specific autoantibodies.
Findings:
- Treatment with methylprednisolone and oral prednisone initiated the improvement.
- Subsequent initiation of antiretroviral triple therapy led to significant clinical and biologic recovery.
- This case highlights the potential for effective management of co-occurring HIV and lupus nephritis.
Implications:
- This is the first reported case of lupus-like nephritis in a Caucasian child with AIDS.
- Combined steroid and antiretroviral therapy may significantly improve outcomes for such patients.
- Further research is warranted to understand the pathogenesis and optimize treatment strategies for this rare condition.
Abstract:
Concomitant acquired immunodeficiency syndrome (AIDS) and lupus nephritis is an exceptional feature in white patients. A white boy with maternofetal human immunodeficiency virus (HIV) infection had no medical follow-up until he presented at 12 years of age with a nephrotic syndrome, macrohematuria, renal failure, pancytopenia, and low CD4(+) cell count. A renal biopsy revealed severe lupus nephritis (World Health Organization class IV) with specific immune deposits in the absence of any clinical sign of systemic lupus erythematosus or specific autoantibodies at the time of diagnosis. The treatment consisted of methylprednisolone pulses followed by oral prednisone; antiretroviral triple therapy was started a few weeks later, which contributed to clinical and biologic improvement. To our knowledge, this is the first case report of lupus-like nephritis in a white child with AIDS, whose outcome might be improved significantly by a combination of steroids and antiretroviral therapy.