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New-onset systemic lupus erythematosus in a long-term hemodialysis patient with acute pleuritis and pneumonitis

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Abstract

A 61-year-old woman, with a 25-year history of maintenance hemodialysis due to end-stage renal disease of unknown causes, was admitted because of systemic joint pain and inflammatory response of unknown etiology that persisted for 1 month. Laboratory data on admission revealed leukocytopenia, lymphocytopenia, high serum C-reactive protein, and positivity for antinuclear antibody (ANA) and anti-double strand DNA. After admission, she progressively developed cough and dyspnea. A chest radiograph revealed bilateral ground glass opacity and pleural effusion. A thoracentesis revealed lupus erythematosus cells, suggesting lupus pleuritis. A chest computed tomography showed a pattern of diffuse alveolar damage compatible with acute lupus pneumonitis. She fulfilled the American Rheumatism Association diagnostic criteria for systemic lupus erythematosus (SLE). Methylprednisolone pulse therapy followed by oral prednisone treatment improved the clinical symptoms and laboratory abnormalities. ANA was negative 25 years earlier when she first started hemodialysis and she had neither clinical nor serological abnormalities related to SLE during the last 25 years. Further, she had neither received drugs that can cause drug-induced SLE, nor had a history of ultraviolet ray exposure, pregnancy, blood transfusion, trauma and smoking. This report suggests that new-onset SLE can develop in patients undergoing long-term dialysis. Hence, when we encounter dialysis patients with arthralgia and/or respiratory disorders, we should consider the possibility of new-onset SLE.

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Acknowledgments

We thank Edanz Editing (http://www.edanzediting.co.jp/) for carefully reading and preparing our manuscript.

Conflict of interest

Honoraria: Kazuhiko Tsuruya (Kyowa Hakko Kirin Co., Chugai Pharmaceutical Co.), Research funding: Kazuhiko Tsuruya (Kyowa Hakko Kirin Co., Chugai Pharmaceutical Co., Fuso Pharmaceutical Industries, MSD K.K., Takeda Pharmaceutical Co.), Endowed department: Kazuhiko Tsuruya (Baxter).

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Authors and Affiliations

  1. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Hiroto Hiyamuta, Shunsuke Yamada, Ryusuke Yotsueda, Shoko Hasegawa, Toshiaki Nakano, Masatomo Taniguchi, Takanari Kitazono & Kazuhiko Tsuruya

  2. Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Hiroshi Tsukamoto

  3. Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Kazuhiko Tsuruya

Authors
  1. Hiroto Hiyamuta
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  2. Shunsuke Yamada
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  3. Ryusuke Yotsueda
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  4. Shoko Hasegawa
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  5. Toshiaki Nakano
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  6. Masatomo Taniguchi
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  7. Hiroshi Tsukamoto
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  8. Takanari Kitazono
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  9. Kazuhiko Tsuruya
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Corresponding author

Correspondence to Kazuhiko Tsuruya.

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Hiyamuta, H., Yamada, S., Yotsueda, R. et al. New-onset systemic lupus erythematosus in a long-term hemodialysis patient with acute pleuritis and pneumonitis. CEN Case Rep 4, 139–144 (2015). https://doi.org/10.1007/s13730-014-0155-9

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  • DOI: https://doi.org/10.1007/s13730-014-0155-9

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