Sedai Hari, Shrestha Suraj, Aryal Roshan, Acharya Suman, Adhikari Sugat, Karki Nabin
Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.
Department of Internal Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Ann Med Surg (Lond). 2025 May 21;87(6):3906-3910. doi: 10.1097/MS9.0000000000003291. eCollection 2025 Jun.
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.
系统性红斑狼疮（SLE）和镰状细胞病（SCD）是相对常见的疾病，但它们在个体中共存的情况却很罕见。由于这两种疾病在肌肉骨骼、中枢神经系统和肾脏表现方面存在相似性，因此很难对患有SCD的患者做出SLE的诊断。SCD和镰状细胞性状（SCT）在慢性肾脏病（CKD）的进展过程中都可能产生累积性损害。
我们报告了一例来自尼泊尔SCD流行地区的23岁女性病例，该患者最初表现为尿路感染症状，但后来被诊断为同时患有SCT和SLE。对其进行了肾脏活检，结果发现狼疮性肾炎的证据，但未发现镰状细胞肾病的证据。她接受了免疫抑制药物治疗。
尽管SCT和SLE合并出现的情况鲜有描述，但它们相关的临床特征，如慢性进展和肾脏受累，使得鉴别诊断更加困难。通常需要进行肾脏活检，以区分由自身免疫过程引起的狼疮性肾炎和与红细胞适度局部镰变相关的SCT相关性肾损伤。准确识别肾脏异常对于指导治疗和改善患者预后至关重要。
SCT和SLE都可能有多种系统表现且抗核抗体呈阳性。两者共存可加速肾脏损害的速度，但情况并不总是相同，可能因病例而异。
