CLASS IV LUPUS NEPHRITIS, THROMBOTIC MICROANGIOPATHY, AND EXTENSIVE LONGITUDINAL MYELITIS AS AN INITIAL MANIFESTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS - CASE REPORT

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease whose patients present with variable clinical features, from mild joint and skin involvement to life-threatening renal, hematologic, or central nervous system involvement. Most patients with systemic lupus erythematosus will have clinical evidence of renal disease. Antiphospholipid syndrome (APS) is the association of thrombosis and/or gestational morbidity with antiphospholipid antibodies (aPL). Thirty to forty percent of patients with systemic lupus erythematosus have positive results for aPL, which may impact the presentation, management, and prognosis of SLE. Any organ or system can be affected by APS. It may present with thrombotic microangiopathy, as has been observed in APS nephropathy. Myelitis is an inflammatory disease that manifests with rapidly progressive motor, sensory, and autonomic symptoms with catastrophic results. Neuropsychiatric manifestations (NPM) in systemic lupus erythematosus have a significant impact on the prognosis of the disease due to their frequency and severity. Myelopathy is a rare manifestation of the central nervous system (CNS) in SLE and affects 1% to 2% of patients. This case report aims to alert health professionals to the diagnosis of SLE in the general population and its main presentations, as well as its atypical and rare manifestations, such as the triple presentation of the onset of lupus demonstrated in this case: Class IV Lupus Nephritis, Thrombotic Microangiopathy, and Neuromyelitis with extensive longitudinal myelitis. Furthermore, in the literature review searching for the onset of SLE with the triple manifestation mentioned in this case, no such mentions were found.