Rapidly Progressive Lupus Nephritis With Concurrent Anti-GBM and ANCA Positivity: A Rare Case Report.
Gespeichert in:
| Titel: | Rapidly Progressive Lupus Nephritis With Concurrent Anti-GBM and ANCA Positivity: A Rare Case Report. |
|---|---|
| Autoren: | Cao TT; Allergy and Clinical Immunology Department, Hanoi Medical University, Hanoi, Vietnam., Pham HT; Allergy and Clinical Immunology Center, Bach Mai Hospital, Hanoi, Vietnam., Bui VK; Allergy and Clinical Immunology Center, Bach Mai Hospital, Hanoi, Vietnam., Nguyen TMH; Allergy and Clinical Immunology Department, Hanoi Medical University, Hanoi, Vietnam.; Allergy and Clinical Immunology Center, Bach Mai Hospital, Hanoi, Vietnam., Ly VP; Allergy and Clinical Immunology Department, Hanoi Medical University, Hanoi, Vietnam., Bui VD; Allergy and Clinical Immunology Department, Hanoi Medical University, Hanoi, Vietnam.; Department of Allergy, Immunology and Dermatology, e Hospital, Hanoi, Vietnam., Thai NH; Allergy and Clinical Immunology Center, Bach Mai Hospital, Hanoi, Vietnam., Nguyen MH; Allergy and Clinical Immunology Center, Bach Mai Hospital, Hanoi, Vietnam., Nguyen HP; Allergy and Clinical Immunology Department, Hanoi Medical University, Hanoi, Vietnam.; Allergy and Clinical Immunology Center, Bach Mai Hospital, Hanoi, Vietnam. |
| Quelle: | Case reports in nephrology [Case Rep Nephrol] 2025 Sep 09; Vol. 2025, pp. 4767868. Date of Electronic Publication: 2025 Sep 09 (Print Publication: 2025). |
| Publikationsart: | Case Reports; Journal Article |
| Sprache: | English |
| Info zur Zeitschrift: | Publisher: Wiley Country of Publication: United States NLM ID: 101598418 Publication Model: eCollection Cited Medium: Print ISSN: 2090-6641 (Print) Linking ISSN: 2090665X NLM ISO Abbreviation: Case Rep Nephrol Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Publication: 2023- : [Hoboken, NJ] : Wiley Original Publication: New York, NY : Hindawi Pub. Corp. |
| Abstract: | Background: Rapidly progressive lupus nephritis (LN) with concurrent positivity for anti-glomerular basement membrane (anti-GBM) antibodies and antineutrophil cytoplasmic antibodies (ANCAs) represents an exceptionally rare and severe autoimmune overlap. Early identification and timely intervention are critical to prevent irreversible renal damage. Case Presentation: A 23-year-old woman with systemic lupus erythematosus presented with acute kidney injury, nephrotic-range proteinuria, pancytopenia, and a SLEDAI score of 41. Serologic tests revealed high-titer anti-GBM antibodies and dual ANCA positivity (MPO and PR3) by the ELISA technique. Although the patient experienced mild hemoptysis and a significant drop in hemoglobin, MSCT of pulmonary vasculature and parenchyma did not reveal alveolar hemorrhage or vascular lesions. Due to contraindications to renal biopsy, she was empirically treated with pulse-dose corticosteroids and plasma exchange, followed by oral corticosteroids and mycophenolate mofetil. Anti-GBM antibodies became undetectable after seven sessions. The patient achieved full clinical, biochemical, and renal remission within 2 months. Conclusion: This case highlights the importance of early serologic evaluation and prompt immunosuppressive therapy in rapidly progressive LN with anti-GBM/ANCA overlap, particularly when histopathological confirmation is not feasible. (Copyright © 2025 Thi Trinh Cao et al. Case Reports in Nephrology published by John Wiley & Sons Ltd.) |
| Competing Interests: | The authors declare no conflicts of interest. |
| References: | Expert Opin Pharmacother. 2024 Oct;25(15):2061-2076. (PMID: 39402707) Kidney Int. 2012 Oct;82(8):840-56. (PMID: 22895519) Kidney360. 2022 Jan 27;3(1):5-7. (PMID: 35368575) J Autoimmun. 2021 May;119:102615. (PMID: 33631651) Case Rep Rheumatol. 2018 Nov 19;2018:3076806. (PMID: 30581646) J Nephropathol. 2014 Jul;3(3):115-20. (PMID: 25093160) Kidney Int. 2017 Sep;92(3):693-702. (PMID: 28506760) Front Immunol. 2020 Dec 14;11:597863. (PMID: 33381119) Clin J Am Soc Nephrol. 2017 Jul 7;12(7):1162-1172. (PMID: 28515156) |
| Entry Date(s): | Date Created: 20250918 Date Completed: 20250918 Latest Revision: 20250920 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12440640 |
| DOI: | 10.1155/crin/4767868 |
| PMID: | 40964236 |
| Datenbank: | MEDLINE |
Full Text 
Full Text Finder 
Nájsť tento článok vo Web of Science | Abstract: | Background: Rapidly progressive lupus nephritis (LN) with concurrent positivity for anti-glomerular basement membrane (anti-GBM) antibodies and antineutrophil cytoplasmic antibodies (ANCAs) represents an exceptionally rare and severe autoimmune overlap. Early identification and timely intervention are critical to prevent irreversible renal damage. Case Presentation: A 23-year-old woman with systemic lupus erythematosus presented with acute kidney injury, nephrotic-range proteinuria, pancytopenia, and a SLEDAI score of 41. Serologic tests revealed high-titer anti-GBM antibodies and dual ANCA positivity (MPO and PR3) by the ELISA technique. Although the patient experienced mild hemoptysis and a significant drop in hemoglobin, MSCT of pulmonary vasculature and parenchyma did not reveal alveolar hemorrhage or vascular lesions. Due to contraindications to renal biopsy, she was empirically treated with pulse-dose corticosteroids and plasma exchange, followed by oral corticosteroids and mycophenolate mofetil. Anti-GBM antibodies became undetectable after seven sessions. The patient achieved full clinical, biochemical, and renal remission within 2 months. Conclusion: This case highlights the importance of early serologic evaluation and prompt immunosuppressive therapy in rapidly progressive LN with anti-GBM/ANCA overlap, particularly when histopathological confirmation is not feasible.<br /> (Copyright © 2025 Thi Trinh Cao et al. Case Reports in Nephrology published by John Wiley & Sons Ltd.) |
|---|---|
| ISSN: | 2090-6641 |
| DOI: | 10.1155/crin/4767868 |