2025 Volume 38 Article ID: cr.24-026
A 16-year-old male patient was diagnosed with systemic lupus erythematosus and class IV-G(A) lupus nephritis 2 years before presentation. He was treated with methylprednisolone pulse therapy, oral prednisolone (PSL), hydroxychloroquine (HCQ), and mycophenolate mofetil (MMF), which resulted in remission; however, he decided to discontinue his treatment after 7 months. One year later, the patient presented to our hospital with fever and generalized edema, as well as hypertension, renal dysfunction, and severe proteinuria. Renal histopathology revealed class IV-G(A), thrombosis and fibrinoid necrosis in the vascular pole and loop walls. Although there was no hemolytic anemia, the findings were characteristic of thrombotic microangiopathy or antiphospholipid antibody syndrome nephropathy. He was started on PSL and received three courses of methylprednisolone pulse therapy. HCQ and MMF were included to maintain remission, and the patient was administered PSL, HCQ, and MMF for approximately 18 months after relapse. He experienced persistent renal dysfunction, and there was concern that the disease might progress to chronic kidney disease.
