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Complex Case Study: Lupus Nephritis and Thromboembolic Events in a Young Female

This case study follows a 24-year-old female diagnosed with systemic lupus erythematosus (SLE) in April 2005, complicated by thromboembolic events such as deep vein thrombosis (DVT) and extensive pulmonary embolism (PE), autoimmune hemolytic anemia (AIHA), and pulmonary hypertension. Despite treatment for community-acquired pneumonia (CAP) and tuberculosis (TB), investigations revealed a cavitary lung lesion, leading to a lung biopsy confirming thromboembolic arteriopathy associated with SLE and pulmonary hypertension. Lab results showed low C3/C4 levels, proteinuria, and renal involvement. Renal biopsy indicated mesangial proliferative lupus nephritis of mild activity. The patient experienced readmission for pneumonia and possible nephrotic syndrome, with further diagnostic findings on immunofluorescence. Managed with steroids and plaquenil, this complex case highlights the multidisciplinary approach required in lupus-related complications.

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Complex Case Study: Lupus Nephritis and Thromboembolic Events in a Young Female

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  1. U05-9799 #015016274755 • 24 Year old female dx SLE April 2005 • Complicated by thromboebolic events including DVT and extensive PE, AIHA, pulm. HTN • March 2005 • Treated in Fort Mac for CAP/ TB • CT showed cavitary lung lesion, TB w/u negative • Had open lung Bx for cavitating lung disease – thromboembolic arteripathy c/w SLE and evidence pulm.HTN • Anti-dsDNA, ANCA neg, ANA pos, HIV/Hep C neg • C3/C4 0.031/0.03 (Low) • P:C 96.67, Cr 30 • Followed by Dr. Aaron and given steroids/plaquenil • May 2005 –Readmitted to hospital for CAP and ? nephrotic syndrome • Cr 48, Alb 22, P:Cr 415.63, LDL1.28, U/A -1-5 RBC, 3+ prot, 0 HB (sg 1.031) cytodiag occ. Heme gran casts, wbc casts • O/E BP 121/80, JVP N, 3+ pitting edema

  2. IF • IgG- Moderate mesangial staining • IgA- Mild-moderate mesangial staining • IgM- Moderate mesangial staining • C3- Mild mesangial staining • C1q- Moderate mesangial and vascular staining • Kappa- Mild mesangial staining • Lambda- Moderate mesangial staining • Fibrin- Moderate interstitial staining • Albumin- Mild hyalen droplet change in tubular cytoplasm

  3. IgG

  4. IgA

  5. IgM

  6. C3

  7. Clq

  8. Clq

  9. Kappa

  10. Lambda

  11. Fibrin

  12. Albumin

  13. Lambda

  14. Kappa

  15. Diagnosis:Renal Biopsy:Mesangial proliferative lupus nephritis of mild activity and no chronicity

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