Rheumatology International

, Volume 25, Issue 2, pp 130–132 | Cite as

Unusual presentation of lupus nephritis

  • R. GuptaEmail author
  • N. Gulati
  • A. Gupta
  • A. Kumar
  • A. K. Dinda
  • S. K. Sharma
Case Report


We report a male patient who presented with pyrexia, generalized lymphadenopathy, hepatosplenomegaly, and pleural effusion with no cutaneous or musculoskeletal symptoms. Despite extensive investigation, no cause was detected. His initial serology was also negative for autoantibodies. The patient was placed on a trial of antitubercular treatment in view of a positive Mantoux test. His disease evolved into the full clinical picture of systemic lupus erythematosus with nephritis (World Health Organisation class IV) and strongly positive antinuclear antibody and dsDNA over a period of months. He was treated successfully with intravenous cyclophosphamide pulses along with oral prednisolone, and the disease was still in remission after 3 years of follow-up.


Lymphadenopathy Nephritis Systemic lupus erythematosus 


  1. 1.
    Fox RA, Rosahn PD (1943) The lymph node in disseminated lupus erythematosus. Am J Pathol 19:73–99Google Scholar
  2. 2.
    Rothfield NF, Bierer WF, Garfield JW (1978) Isoniazid induction of anti-nuclear antibodies: a prospective study. Ann Intern Med 88:650–652PubMedGoogle Scholar
  3. 3.
    Dhand R, Gilhotra R, Sehgel S, Malik SK (1987) Incidence of isoniazid-induced anti-nuclear antibodies in patients of tuberculosis. Indian J Med Res 85:503–507PubMedGoogle Scholar
  4. 4.
    Salazae-Parmo M, Rubin RL, Garcia T (1992) Isoniazid induced systemic lupus erythematosus. Ann Rheum Dis 51:1085–1087PubMedGoogle Scholar
  5. 5.
    Biner B, Acunas B, Karasalihoglu S, Vatansever U (2001) Systemic lupus erythematosus presenting with generalized lymphadenopathy: a case report. Turk J Pediatr 43:94–96PubMedGoogle Scholar
  6. 6.
    Dubois EL, Tuffanelli DL (1964) Clinical manifestation of systemic lupus erythematosus: computer analysis of 520 cases. JAMA 190:104–111PubMedGoogle Scholar
  7. 7.
    Cervera R, Khamashta MA, Font J et al (1993) Systemic lupus erythematosus: clinical and immunologic pattern of disease expression in a cohort of 1,000 patients. Medicine 72:113–124PubMedGoogle Scholar
  8. 8.
    Kassan SS, Moss ML, Reddick RL (1976) Progressive hilar and mediastinal lymphadenopathy in systemic lupus erythematosus on corticosteroid therapy. N Engl J Med 294:1382–1383PubMedGoogle Scholar
  9. 9.
    Kojima M, Nakamura S, Morishta Y (2000) Reactive follicular hyperplasia in the lymph node lesions from systemic lupus erythematosus patients—a clinicopathological and immunohistological study of 21 cases. Pathol Int 50:30–42CrossRefGoogle Scholar
  10. 10.
    Palestro G, Turrini F, Pagano M, Chiusa L (1999) Castleman’s disease. Adv Clin Path 3:11–22PubMedGoogle Scholar
  11. 11.
    Dorfman DF, Berry GJ (1988)Kikuchi’s histiocytic necrotising lymphadenitis: an analysis of 108 cases with emphasis on differential diagnosis. Semin Diagn Pathol 5:329–345PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • R. Gupta
    • 1
    Email author
  • N. Gulati
    • 1
  • A. Gupta
    • 1
  • A. Kumar
    • 1
  • A. K. Dinda
    • 2
  • S. K. Sharma
    • 1
  1. 1.Clinical Immunology and Rheumatology Services, Department of MedicineAll India Institute of Medical SciencesNew Delhi India
  2. 2.Department of PathologyAll India Institute of Medical SciencesNew DelhiIndia

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