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[Diffuse proliferative lupus nephritis in a patient with ulcerative colitis]
T Sugiyama1, Y Oishi, M Sueishi
1Department of Internal Medicine, Shimoshizu National Hospital, Chiba.
Ryumachi. [Rheumatism]
|August 1, 1996
Summary
A patient developed lupus-like symptoms including nephrotic syndrome while on sulfasalazine. The condition was diagnosed as idiopathic systemic lupus erythematosus, not drug-induced lupus.
Area of Science:
- Nephrology
- Rheumatology
- Immunology
Background:
- Sulfasalazine is a medication used to treat inflammatory bowel disease.
- Drug-induced lupus erythematosus (DILE) can mimic idiopathic lupus.
- Distinguishing between DILE and idiopathic lupus is crucial for effective treatment.
Observation:
- A 31-year-old male patient on sulfasalazine for ulcerative colitis presented with nephrotic syndrome, photosensitivity, alopecia, lymphopenia, and hypocomplementemia.
- Laboratory tests revealed positive antinuclear antibody (speckled), anti-single-stranded DNA, and anti-SS-A antibodies.
- Renal biopsy confirmed diffuse proliferative lupus nephritis.
Findings:
- The patient's nephrotic syndrome showed partial improvement with corticosteroids and sulfasalazine cessation.
- Complement levels normalized but decreased upon corticosteroid tapering.
- The clinical and serological profile led to a diagnosis of idiopathic systemic lupus erythematosus (SLE).
Implications:
- This case highlights the importance of considering idiopathic SLE even in patients taking potential culprit medications.
- Careful monitoring of complement levels and clinical symptoms is essential during treatment.
- The findings underscore the complex interplay between medication and autoimmune disease presentation.