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Case Report: Sequential eculizumab and belimumab in a paediatric patient with lupus nephritis and immune
Ruiqi Zhu1, Meng Liu1, Xuechan Huang1
1Department of Rheumatology and Immunology, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China.
Background:
Renal microangiopathy is a severe complication of systemic lupus erythematosus, particularly when mediated by immune complex deposition. The optimal management of paediatric immune complex-mediated renal microangiopathy with rapid clinical deterioration remains unclear, and data on sequential complement and B-cell targeted therapy in this setting are scarce.
Case Summary:
A previously healthy 14-year-old Chinese male patient presented with joint pain and generalised oedema. He was diagnosed with systemic lupus erythematosus, and the renal biopsy confirmed lupus nephritis (IV combined with V type) and immune complex-mediated renal microangiopathy (IC-RMA). The patient received a first-line intensive treatment regimen and showed an insufficient clinical response. Considering the severity and suspected complement-driven injury, we then initiated eculizumab, and his joint pain, generalised oedema, haematuria, proteinuria, and SLEDAI score were all improved. Belimumab was subsequently administered after 3 months of eculizumab therapy, and there was no recurrence for 1 year later.
Conclusion:
Sequential eculizumab and belimumab may be potential alternatives for selected paediatric patients with IC-RMA, although further studies are needed to confirm their efficacy and safety.
