Phadke Chetan, Sajgure Atul, Bale Charan, Wakhare Pavan, Shinde Nilesh, Chavan Abhijit, Kulkarni Akshay, Godbole Shreeharsh, Makan Anuja, Saha Debapriya, Dighe Tushar
Department of Nephrology, Dr D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India.
Nephrology Services, Dr D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India.
Middle East J Dig Dis. 2024 Jan;16(1):69-71. doi: 10.34172/mejdd.2024.372. Epub 2024 Jan 31.
Systemic lupus erythematosus (SLE) is a multi-systemic disorder affecting almost all systems of the body. Involvement of the kidney in this condition is known as lupus nephritis (LN). LN is one of the important disease manifestations of SLE with considerable influence on patient outcomes in terms of morbidity and mortality. A 33-year-old female came to the OPD with complaints of abdominal pain, infrequent loose stools since 4 months. The patient also had joint pain, predominantly small joints, since 2 months. Patient was admitted and all routine investigations were done. Patient underwent an oesophagogastroduodenoscopy (OGD) and colonoscopy for her abdominal pain and loose stools which did not respond to routine medication. Grossly there was edema present in the oesophagus and colon which on microscopy showed eosinophilic infiltration. Urine routine of the patient showed protein 1+and 24-hour urine protein quantification of 1427 mg/24 h. On further evaluation patient was found to have a positive ANA blot (dsDNA, AMAM2, Ro52 and Sm). The patient was planned for a renal biopsy in view of the proteinuria and positive ANA blot. The patient underwent a renal biopsy under USG guidance and was found to have Lupus nephritis Class 3 (ISN RPS staging). SLE is a multi-organ involving disease which if not diagnosed at the earliest can have serious complications and lead to end stage organ failure and even death. Atypical presentations often pose a diagnostic dilemma and may delay diagnosis and treatment. Early diagnosis and treatment can give patients of SLE a long and normal life. Diagnostic guidelines have helped in the diagnosis of such atypical presentations.
系统性红斑狼疮（SLE）是一种多系统疾病，几乎会影响身体的所有系统。肾脏受累在这种情况下被称为狼疮性肾炎（LN）。LN是SLE的重要疾病表现之一，对患者的发病率和死亡率方面的预后有相当大的影响。一名33岁女性因腹痛、4个月来稀便次数少而前来门诊。患者自2个月以来还出现关节疼痛，主要是小关节疼痛。患者入院后进行了所有常规检查。患者因腹痛和稀便对常规药物无反应而接受了食管胃十二指肠镜检查（OGD）和结肠镜检查。肉眼可见食管和结肠有水肿，显微镜检查显示嗜酸性粒细胞浸润。患者尿常规显示蛋白1+，24小时尿蛋白定量为1427mg/24h。进一步评估发现患者抗核抗体印迹（dsDNA、AMAM2、Ro52和Sm）呈阳性。鉴于蛋白尿和抗核抗体印迹阳性，计划对该患者进行肾活检。患者在超声引导下进行了肾活检，结果发现患有3级狼疮性肾炎（国际肾脏病学会/肾脏病理学会分期）。SLE是一种多器官受累疾病，如果不及早诊断，可能会出现严重并发症，导致终末期器官衰竭甚至死亡。非典型表现常常造成诊断困境，可能会延误诊断和治疗。早期诊断和治疗可以让SLE患者过上漫长而正常的生活。诊断指南有助于诊断此类非典型表现。
