Rowell's Syndrome to ds-DNA Negative Lupus Nephritis: A Yet Unreported Progression

Area of Science:

• Rheumatology
• Nephrology
• Dermatology

Background:

• Rowell's syndrome is a rare subtype of subacute cutaneous lupus erythematosus.
• It presents with characteristic skin lesions, positive rheumatoid factor, anti-Ro/La antibodies, and speckled antinuclear antibodies.
• Lupus nephritis (LN) is a severe complication of lupus erythematosus, often drug-induced.

Purpose of the Study:

• To report a unique case of Rowell's syndrome.
• To describe its progression to non-drug-induced, ds-DNA negative lupus nephritis.
• To highlight the rarity of cutaneous involvement in such cases.

Main Methods:

• Case report of an 18-year-old female.
• Clinical evaluation including dermatological and renal assessments.
• Serological testing for ds-DNA, rheumatoid factor, anti-Ro/La antibodies, and antinuclear antibodies.

Main Results:

• The patient presented with Rowell's syndrome.
• She was negative for ds-DNA antibodies.
• Over four months, she progressed to stage V lupus nephritis, a rare occurrence for non-drug-induced LN with negative dsDNA and cutaneous involvement.

Conclusions:

• Rowell's syndrome can rarely progress to severe, non-drug-induced lupus nephritis.
• This case underscores the importance of monitoring for renal complications even in the absence of ds-DNA antibodies.
• The co-occurrence of Rowell's syndrome and ds-DNA negative LN with cutaneous manifestations is exceptionally rare.