Patient with class V lupus nephritis (LN) treated with intravenous immunoglobulin (IVIG) achieving a favourable...

This case highlights the use of intravenous immunoglobulin (IVIG) in a patient with refractory pure class V lupus nephritis (LN), a challenging subtype of LN. A woman in her 30s with systemic lupus erythematosus developed severe proteinuria and could not tolerate standard immunosuppressants due to life-threatening infections. IVIG, though not a guideline-recommended therapy for class V LN, was initiated as an alternative. Over a 6-month period, the urinary protein-to-creatinine ratio decreased significantly, resulting in sustained renal remission. IVIG's mechanism involves modulating immunity, neutralising autoantibodies and reducing inflammation with a favourable safety profile compared with glucocorticoids and mycophenolate. While the current literature lacks robust trials, case reports and limited studies suggest that IVIG has the potential to treat difficult-to-treat LN. This case highlights the potential role of IVIG in LN and advocates for further research to establish its efficacy in managing class V LN, particularly in patients unable to tolerate conventional therapies.