Abstract
An 85-year-old Japanese woman with hypertension and diabetes was receiving several medications, including hydrochlorothiazide, and presented with a 3-week history of bilateral leg edema. Laboratory test results indicated renal dysfunction and proteinuria. Further evaluation revealed bicytopenia, and tests for antinuclear antibody and anti-double-stranded DNA were positive. Drug-induced lupus was initially considered, but her condition did not improve following hydrochlorothiazide discontinuation. Thus, late-onset lupus was diagnosed. Late-onset lupus is characterized by an insidious onset with nonspecific manifestations, and it is difficult to diagnose. Unexplained cytopenia in the elderly may be an essential characteristic to consider in late-onset lupus diagnosis.
