Premium
Sun‐Induced Life‐Threatening Lupus Nephritis
Author(s) -
SCHMIDT ENNO,
TONY HANSPETER,
BRÖCKER EVABETTINA,
KNEITZ CHRISTIAN
Publication year - 2007
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1196/annals.1422.004
Subject(s) - lupus nephritis , medicine , nephritis , systemic lupus erythematosus , immunology , dermatology , disease
Abstract : Photosensitivity is a widely known characteristic of both cutaneous and systemic lupus erythematosus (LE). However, sun‐induced organ involvement is rarely reported in LE. We describe a 34‐year‐old woman who had been in complete remission of systemic LE for more than 8 years without treatment. After sunbathing, she developed acute sunburn followed by cutaneous LE in sun‐exposed areas. Six weeks later, a lupus nephritis was diagnosed and high serum levels of anti‐double‐stranded (ds) DNA and anti‐Ro/SSA antibodies were detected. Treatment with systemic cyclophosphamide and prednisolone led to septicemia requiring assisted ventilation for more than 2 weeks and repeated hemodialysis. Clinical remission was achieved 3 months later by the use of prednisolone and mycophenolate mofetile. Meanwhile, mild proteinuria persisted, anti‐dsDNA antibodies normalized. We hypothesize that the sunburn‐induced keratinocyte necrosis/apoptosis exposed intracellular antigens as trigger for the generation of autoantibodies that finally mediated immune‐complex nephritis. The patient highlights the impact of UV light not only on skin but also on internal organ involvement in LE.