Coexisting systemic lupus erythematosus with lupus nephritis and sickle cell trait: a case report of rare combination

Systemic lupus erythematosus (SLE) and sickle cell disease (SCD) are relatively common disorders but their coexistence in an individual is rare. Because of the similarities in the musculoskeletal, central nervous system, and renal manifestations in both diseases, diagnosis of SLE in patients with SCD can be difficult to establish. Both the SCD and sickle cell trait (SCT) can have a cumulative assault in the progression of chronic kidney disease (CKD).

We report a case of a 23-year-old female from an endemic region of SCD in Nepal who presented initially with the symptoms of urinary tract infection but was diagnosed later to have coexistent SCT with SLE. A biopsy of the kidney was done where evidence of lupus nephritis was found with no evidence of sickle cell nephropathy. She was managed with immunosuppressive medications.

Although SCT and SLE are infrequently described combined, their related clinical characteristics, such as chronic progression and renal involvement, make identification more difficult. A renal biopsy is frequently necessary to distinguish between lupus nephritis, which is caused by autoimmune processes, and SCT-related kidney injury, which is associated with modest and localized sickling of red blood cells. Accurate identification of renal abnormalities is critical for guiding treatment and improving patient outcomes.

Both SCT and SLE can have multisystem manifestations with positive anti-nuclear antibodies. The coexistence of both can accelerate the rate of kidney damage but isn't always the same as it may differ from case to case.