Systemic Lupus Erythematosus Without Kidney Involvement: A Case Report

In a retrospective study of 242 cases of non-infectious cryoglobulinemia-associated vasculitis, corticosteroids and rituximab were efficacious in the treatment of the clinical, kidney and immunologic sequelae of cryoglobulinemia.⁶

After treatment with a single dose of rituximab and continued maintenance therapy with hydroxychloroquine, azathioprine, prednisone and lisinopril, her kidney function remains normal and her proteinuria decreased to less than 500 mg/day. Complements remained low despite treatment. Her blood pressure is well controlled, and she has had no further LCV.

Unfortunately, subsequent rituximab infusions have been delayed due to insurance coverage, and she coincidentally developed new papillary thyroid cancer, resulting in total thyroidectomy, and cervical intraepithelial neoplasia II/III for which a hysterectomy is planned. After she recovers from her hysterectomy, she will receive further rituximab infusions.

Lindsey MacFarlane, MD, is a second-year rheumatology fellow at Brigham and Women’s Hospital. She is currently pursuing her MPH and has a research interest in osteoarthritis.

Paul Hoover, MD, PhD, is a second-year rheumatology fellow at Brigham and Women’s Hospital, starting his post-doctoral work at the Broad Institute investigating gene regulation in autoimmunity. He graduated from the Medical Scientist Training Program from Stanford University and completed his internal medicine residency at Brigham and Women’s Hospital.

Acknowledgments

The authors would like to thank Helmut Rennke, MD, for supplying the light and electron microscopy images from the kidney biopsy and thoughtful conversations, and Elena Massarotti, MD, for proofreading the manuscript.

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